| 1 | 1 | | II |
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| 2 | 2 | | 119THCONGRESS |
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| 3 | 3 | | 1 |
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| 4 | 4 | | STSESSION S. 506 |
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| 5 | 5 | | To require the Secretary of Veterans Affairs to carry out a pilot program |
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| 6 | 6 | | to coordinate, navigate, and manage care and benefits for veterans en- |
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| 7 | 7 | | rolled in both the Medicare program and the system of annual patient |
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| 8 | 8 | | enrollment of the Department of Veterans Affairs. |
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| 9 | 9 | | IN THE SENATE OF THE UNITED STATES |
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| 10 | 10 | | FEBRUARY11, 2025 |
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| 11 | 11 | | Mr. M |
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| 12 | 12 | | ORAN(for himself and Mr. KING) introduced the following bill; which |
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| 13 | 13 | | was read twice and referred to the Committee on Veterans’ Affairs |
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| 14 | 14 | | A BILL |
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| 15 | 15 | | To require the Secretary of Veterans Affairs to carry out |
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| 16 | 16 | | a pilot program to coordinate, navigate, and manage |
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| 17 | 17 | | care and benefits for veterans enrolled in both the Medi- |
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| 18 | 18 | | care program and the system of annual patient enroll- |
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| 19 | 19 | | ment of the Department of Veterans Affairs. |
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| 20 | 20 | | Be it enacted by the Senate and House of Representa-1 |
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| 21 | 21 | | tives of the United States of America in Congress assembled, 2 |
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| 22 | 22 | | SECTION 1. SHORT TITLE. 3 |
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| 23 | 23 | | This Act may be cited as the ‘‘Coordinating Care for 4 |
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| 24 | 24 | | Senior Veterans and Wounded Warriors Act’’. 5 |
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| 26 | 26 | | kjohnson on DSK7ZCZBW3PROD with $$_JOB 2 |
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| 27 | 27 | | •S 506 IS |
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| 28 | 28 | | SEC. 2. PILOT PROGRAM ON COORDINATION OF CARE BE-1 |
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| 29 | 29 | | TWEEN DEPARTMENT OF VETERANS AFFAIRS 2 |
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| 30 | 30 | | AND MEDICARE PROGRAM. 3 |
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| 31 | 31 | | (a) I |
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| 32 | 32 | | NGENERAL.—The Secretary, in consultation 4 |
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| 33 | 33 | | with the Secretary of Health and Human Services, shall 5 |
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| 34 | 34 | | carry out a pilot program (in this section referred to as 6 |
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| 35 | 35 | | the ‘‘pilot program’’) to coordinate, navigate, and manage 7 |
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| 36 | 36 | | care and benefits for covered veterans. 8 |
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| 37 | 37 | | (b) P |
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| 38 | 38 | | URPOSES OFPILOTPROGRAM.—The purposes 9 |
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| 39 | 39 | | of the pilot program are as follows: 10 |
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| 40 | 40 | | (1) To improve access to health care services 11 |
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| 41 | 41 | | for covered veterans at medical facilities of the De-12 |
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| 42 | 42 | | partment of Veterans Affairs, from health care pro-13 |
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| 43 | 43 | | viders under the Veterans Community Care Program 14 |
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| 44 | 44 | | under section 1703 of title 38, United States Code, 15 |
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| 45 | 45 | | from health care providers with which the Depart-16 |
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| 46 | 46 | | ment has established a Veterans Care Agreement 17 |
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| 47 | 47 | | under section 1703A of such title, and from health 18 |
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| 48 | 48 | | care providers participating in the Medicare program 19 |
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| 49 | 49 | | under title XVIII of the Social Security Act (42 20 |
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| 50 | 50 | | U.S.C. 1395 et seq.). 21 |
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| 51 | 51 | | (2) To improve outcomes of care received by 22 |
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| 52 | 52 | | covered veterans. 23 |
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| 53 | 53 | | (3) To improve quality of care received by cov-24 |
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| 54 | 54 | | ered veterans. 25 |
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| 56 | 56 | | kjohnson on DSK7ZCZBW3PROD with $$_JOB 3 |
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| 57 | 57 | | •S 506 IS |
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| 58 | 58 | | (4) To lower costs of care received by covered 1 |
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| 59 | 59 | | veterans. 2 |
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| 60 | 60 | | (5) To eliminate gaps in care and duplication of 3 |
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| 61 | 61 | | services and expenses for covered veterans. 4 |
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| 62 | 62 | | (6) To improve care coordination for covered 5 |
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| 63 | 63 | | veterans, including coordination of patient informa-6 |
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| 64 | 64 | | tion and medical records between providers. 7 |
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| 65 | 65 | | (c) A |
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| 66 | 66 | | DMINISTRATION.— 8 |
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| 67 | 67 | | (1) I |
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| 68 | 68 | | N GENERAL.—The Secretary shall carry 9 |
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| 69 | 69 | | out the pilot program through the Center for Inno-10 |
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| 70 | 70 | | vation for Care and Payment of the Department of 11 |
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| 71 | 71 | | Veterans Affairs. 12 |
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| 72 | 72 | | (2) L |
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| 73 | 73 | | OCATIONS.—The Secretary shall carry out 13 |
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| 74 | 74 | | the pilot program in not less than three but not 14 |
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| 75 | 75 | | more than five Veterans Integrated Service Net-15 |
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| 76 | 76 | | works with a large number of covered veterans and 16 |
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| 77 | 77 | | varying degrees of urbanization, including— 17 |
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| 78 | 78 | | (A) locations that are in rural or highly 18 |
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| 79 | 79 | | rural areas, as determined through the use of 19 |
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| 80 | 80 | | the Rural-Urban Commuting Areas coding sys-20 |
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| 81 | 81 | | tem of the Department of Agriculture; and 21 |
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| 82 | 82 | | (B) locations that are medically under-22 |
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| 83 | 83 | | served. 23 |
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| 84 | 84 | | (d) C |
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| 85 | 85 | | ASEMANAGER.— 24 |
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| 87 | 87 | | kjohnson on DSK7ZCZBW3PROD with $$_JOB 4 |
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| 88 | 88 | | •S 506 IS |
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| 89 | 89 | | (1) ASSIGNMENT OF CASE MANAGER .—In car-1 |
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| 90 | 90 | | rying out the pilot program, the Secretary shall as-2 |
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| 91 | 91 | | sign each covered veteran participating in the pilot 3 |
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| 92 | 92 | | program a case manager responsible for developing 4 |
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| 93 | 93 | | an individualized needs assessment for such veteran 5 |
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| 94 | 94 | | and, based on such assessment, a care coordination 6 |
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| 95 | 95 | | plan with defined treatment goals. 7 |
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| 96 | 96 | | (2) A |
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| 97 | 97 | | CCESSING SERVICES.—A case manager as-8 |
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| 98 | 98 | | signed to a covered veteran under paragraph (1) is 9 |
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| 99 | 99 | | responsible for assisting such veteran in accessing 10 |
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| 100 | 100 | | services needed by such veteran and navigating the 11 |
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| 101 | 101 | | systems of care under the laws administered by the 12 |
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| 102 | 102 | | Secretary and under the Medicare program under 13 |
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| 103 | 103 | | title XVIII of the Social Security Act (42 U.S.C. 14 |
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| 104 | 104 | | 1395 et seq.). 15 |
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| 105 | 105 | | (e) U |
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| 106 | 106 | | SE OFEXISTINGMODELS.—In designing the 16 |
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| 107 | 107 | | pilot program, the Secretary shall, to the extent prac-17 |
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| 108 | 108 | | ticable, use existing models, including value-based care 18 |
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| 109 | 109 | | models, used by commercial health care programs to im-19 |
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| 110 | 110 | | prove access, health outcomes, quality, and customer expe-20 |
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| 111 | 111 | | rience and lower per capita costs. 21 |
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| 112 | 112 | | (f) C |
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| 113 | 113 | | ONTRACTINGWITHPRIVATESECTORENTI-22 |
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| 114 | 114 | | TIES.— 23 |
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| 115 | 115 | | (1) I |
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| 116 | 116 | | N GENERAL.—The Secretary shall, to the 24 |
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| 117 | 117 | | greatest extent practicable, contract with private sec-25 |
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| 119 | 119 | | kjohnson on DSK7ZCZBW3PROD with $$_JOB 5 |
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| 120 | 120 | | •S 506 IS |
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| 121 | 121 | | tor entities carrying out commercial health care pro-1 |
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| 122 | 122 | | grams for assistance in designing, implementing, 2 |
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| 123 | 123 | | and managing care and benefits under the pilot pro-3 |
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| 124 | 124 | | gram, to include providing care coordination. 4 |
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| 125 | 125 | | (2) N |
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| 126 | 126 | | OTIFICATION.—If the Secretary deter-5 |
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| 127 | 127 | | mines that contracting with private sector entities 6 |
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| 128 | 128 | | under paragraph (1) is not practicable, the Sec-7 |
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| 129 | 129 | | retary shall submit to the Committee on Veterans’ 8 |
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| 130 | 130 | | Affairs of the Senate and the Committee on Vet-9 |
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| 131 | 131 | | erans’ Affairs of the House of Representatives— 10 |
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| 132 | 132 | | (A) a notification of that determination; 11 |
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| 133 | 133 | | (B) a description of the steps the Secretary 12 |
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| 134 | 134 | | has taken to contract with a private sector enti-13 |
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| 135 | 135 | | ty; 14 |
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| 136 | 136 | | (C) a justification for why the Secretary 15 |
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| 137 | 137 | | has determined that contracting with a private 16 |
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| 138 | 138 | | sector entity is not practicable; and 17 |
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| 139 | 139 | | (D) a plan for how the Secretary will carry 18 |
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| 140 | 140 | | out the pilot program without contracting with 19 |
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| 141 | 141 | | a private sector entity, including through the 20 |
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| 142 | 142 | | use of employees of the Department of Veterans 21 |
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| 143 | 143 | | Affairs or other government agencies, nonprofit 22 |
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| 144 | 144 | | organizations, or other entities. 23 |
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| 145 | 145 | | (g) M |
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| 146 | 146 | | ETRICS.— 24 |
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| 148 | 148 | | kjohnson on DSK7ZCZBW3PROD with $$_JOB 6 |
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| 149 | 149 | | •S 506 IS |
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| 150 | 150 | | (1) IN GENERAL.—The Secretary shall track 1 |
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| 151 | 151 | | metrics under the pilot program, including the fol-2 |
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| 152 | 152 | | lowing: 3 |
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| 153 | 153 | | (A) The number of veterans participating 4 |
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| 154 | 154 | | in the pilot program, disaggregated by Veterans 5 |
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| 155 | 155 | | Integrated Service Network. 6 |
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| 156 | 156 | | (B) Reliance on health care services ad-7 |
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| 157 | 157 | | ministered by the Secretary. 8 |
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| 158 | 158 | | (C) Reliance on health care services admin-9 |
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| 159 | 159 | | istered under the Medicare program under title 10 |
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| 160 | 160 | | XVIII of the Social Security Act (42 U.S.C. 11 |
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| 161 | 161 | | 1395 et seq.). 12 |
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| 162 | 162 | | (D) Quality of care, including patient out-13 |
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| 163 | 163 | | comes. 14 |
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| 164 | 164 | | (E) Cost of care. 15 |
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| 165 | 165 | | (F) Access to care, including under the 16 |
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| 166 | 166 | | designated access standards developed by the 17 |
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| 167 | 167 | | Secretary under section 1703B of title 38, 18 |
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| 168 | 168 | | United States Code. 19 |
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| 169 | 169 | | (G) Patient satisfaction. 20 |
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| 170 | 170 | | (H) Provider satisfaction. 21 |
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| 171 | 171 | | (I) Care coordination, including timely in-22 |
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| 172 | 172 | | formation sharing and medical documentation 23 |
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| 173 | 173 | | return. 24 |
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| 176 | 176 | | •S 506 IS |
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| 177 | 177 | | (2) ELEMENTS.—In tracking metrics under 1 |
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| 178 | 178 | | paragraph (1), the Secretary shall track information 2 |
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| 179 | 179 | | relating to— 3 |
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| 180 | 180 | | (A) whether care received by a covered vet-4 |
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| 181 | 181 | | eran is related to a service-connected disability 5 |
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| 182 | 182 | | (as defined in section 101 of title 38, United 6 |
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| 183 | 183 | | States Code); 7 |
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| 184 | 184 | | (B) the priority group under section 8 |
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| 185 | 185 | | 1705(a) of title 38, United States Code, 9 |
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| 186 | 186 | | through which each covered veteran was en-10 |
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| 187 | 187 | | rolled in the system of annual patient enroll-11 |
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| 188 | 188 | | ment of the Department of Veterans Affairs 12 |
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| 189 | 189 | | under such section; 13 |
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| 190 | 190 | | (C) the type of care and services provided 14 |
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| 191 | 191 | | to covered veterans; and 15 |
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| 192 | 192 | | (D) the demographics of covered veterans 16 |
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| 193 | 193 | | participating in the pilot program, including 17 |
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| 194 | 194 | | age. 18 |
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| 195 | 195 | | (h) D |
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| 196 | 196 | | URATION.—The Secretary shall carry out the 19 |
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| 197 | 197 | | pilot program for a three-year period beginning on the 20 |
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| 198 | 198 | | commencement of the pilot program. 21 |
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| 199 | 199 | | (i) R |
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| 200 | 200 | | EPORTS.— 22 |
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| 201 | 201 | | (1) D |
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| 202 | 202 | | EVELOPMENT, IMPLEMENTATION, RE-23 |
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| 203 | 203 | | SULTS, AND DESIGN OF PILOT PROGRAM .— 24 |
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| 206 | 206 | | •S 506 IS |
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| 207 | 207 | | (A) IN GENERAL.—Not less frequently 1 |
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| 208 | 208 | | than quarterly during the two-year period be-2 |
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| 209 | 209 | | ginning on the date of the enactment of this 3 |
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| 210 | 210 | | Act, the Secretary shall submit to the Com-4 |
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| 211 | 211 | | mittee on Veterans’ Affairs of the Senate and 5 |
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| 212 | 212 | | the Committee on Veterans’ Affairs of the 6 |
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| 213 | 213 | | House of Representatives a report on the devel-7 |
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| 214 | 214 | | opment, implementation, results, and design of 8 |
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| 215 | 215 | | the pilot program, including information on the 9 |
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| 216 | 216 | | metrics tracked under subsection (g). 10 |
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| 217 | 217 | | (B) F |
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| 218 | 218 | | INAL DESIGN.—One of the reports 11 |
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| 219 | 219 | | required under subparagraph (A) shall contain 12 |
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| 220 | 220 | | a description of the final design of the pilot pro-13 |
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| 221 | 221 | | gram. 14 |
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| 222 | 222 | | (2) R |
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| 223 | 223 | | ESULTS OF PILOT PROGRAM .—Not later 15 |
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| 224 | 224 | | than one year after the submission of the final re-16 |
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| 225 | 225 | | port under paragraph (1), and not less frequently 17 |
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| 226 | 226 | | than annually thereafter during the duration of the 18 |
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| 227 | 227 | | pilot program, the Secretary shall submit to the 19 |
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| 228 | 228 | | Committee on Veterans’ Affairs of the Senate and 20 |
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| 229 | 229 | | the Committee on Veterans’ Affairs of the House of 21 |
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| 230 | 230 | | Representatives a report on the results of the pilot 22 |
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| 231 | 231 | | program. 23 |
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| 232 | 232 | | (3) F |
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| 233 | 233 | | INAL REPORT.—Not later than 180 days 24 |
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| 234 | 234 | | before the termination of the pilot program, the Sec-25 |
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| 236 | 236 | | kjohnson on DSK7ZCZBW3PROD with $$_JOB 9 |
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| 237 | 237 | | •S 506 IS |
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| 238 | 238 | | retary shall submit to the Committee on Veterans’ 1 |
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| 239 | 239 | | Affairs of the Senate and the Committee on Vet-2 |
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| 240 | 240 | | erans’ Affairs of the House of Representatives a 3 |
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| 241 | 241 | | final report on the pilot program, which shall include 4 |
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| 242 | 242 | | the recommendation of the Secretary for whether the 5 |
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| 243 | 243 | | pilot program should be extended or made perma-6 |
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| 244 | 244 | | nent. 7 |
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| 245 | 245 | | (j) D |
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| 246 | 246 | | EFINITIONS.—In this section: 8 |
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| 247 | 247 | | (1) C |
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| 248 | 248 | | OVERED VETERAN .—The term ‘‘covered 9 |
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| 249 | 249 | | veteran’’ means a veteran who is enrolled in both the 10 |
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| 250 | 250 | | Medicare program under title XVIII of the Social 11 |
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| 251 | 251 | | Security Act (42 U.S.C. 1395 et seq.) and the sys-12 |
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| 252 | 252 | | tem of annual patient enrollment of the Department 13 |
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| 253 | 253 | | of Veterans Affairs under section 1705(a) of title 14 |
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| 254 | 254 | | 38, United States Code. 15 |
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| 255 | 255 | | (2) S |
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| 256 | 256 | | ECRETARY.—The term ‘‘Secretary’’ means 16 |
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| 257 | 257 | | the Secretary of Veterans Affairs. 17 |
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| 258 | 258 | | Æ |
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