,i  #aah? ,,congress  #b;d ,session  ,h4
 ,r4 #ajbfg  ,,9 ,,! ,,h\se ,,(         
,,repres5tatives  ,decemb] #c1 #bjbd,mr4
 ,bo/ 7= himself & ,mr4 ,bilirakis7     
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,vet]ans' ,affairs  ,a 
,,bill  ,to improve ! provision ( c>e & 
s]vices "u ! ,vet]ans ,community ,c>e   
,program ( ! ,dep>tm5t ( ,vet]ans       
,affairs1 & = o!r purposes4  #a4 ,%ort  
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,complete !   
,mission ,act ( #bjbd4  7b7 ,table (    
cont5ts ,! table ( cont5ts = ?is ,act is
 z foll[s3 ,sec4 #a4 ,%ort title2 table 
( cont5ts4,title ,i--,improvem5t (      
,vet]ans ,community ,c>e ,program,sec4  
#aja4 ,codification ( requirem5ts =     
eligibility /&>ds = access to community 
c>e f ,dep>tm5t ( ,vet]ans              
,affairs4,sec4 #ajb4 ,requirem5t t      
,secret>y notify vet]ans ( eligibility =
 c>e "u ,vet]ans ,community ,c>e        
,program4,sec4 #ajc4 ,consid]ation "u   
,vet]ans ,community ,c>e ,program (     

vet]an pref]5ce = c>e & ne$ = c>egiv] or
 att5dant4,sec4 #ajd4 ,notification (   
d5ial ( reque/ = c>e "u ,vet]ans        
,community ,c>e ,program4,sec4 #aje4    
,discussion ( teleheal? options "u      
,vet]ans ,community ,c>e ,program4,sec4 
#ajf4 ,use ( value-bas$ reimbursem5t    
models "u ,vet]ans ,community ,c>e      
,program4,sec4 #ajg4 ,ext5sion ( deadl9e
 = submittal ( claims by heal? c>e      
entities & provid]s "u prompt paym5t    
/&>d4,title ,,ii--,o!r ,heal? ,c>e      
,matters,sec4 #bja4 ,plan on e/abli%m5t 
( int]active1 onl9e self-s]vice module =
 c>e4,sec4 #bjb4 ,publication ( wait    
times = c>e at m$ical c5t]s ( ,dep>tm5t 
( ,vet]ans ,affairs4,sec4 #bjc4         
,modification ( requirem5ts = ,c5t] =   
,innovation = ,c>e & ,paym5t ( !        
,dep>tm5t ( ,vet]ans ,affairs &         
requirem5t = pilot program4,sec4 #bjd4  
,/&>diz$ process to det]m9e eligibility 
( cov]$ vet]ans = p>ticipation 9 c]ta9  
m5tal heal? treatm5t programs4,sec4     
#bje4 ,reports4  ,i ,improvem5t (       

,vet]ans ,community ,c>e ,program  #aja4
 ,codification ( requirem5ts =          
eligibility /&>ds = access to community 
c>e f ,dep>tm5t ( ,vet]ans ,affairs  7a7
 ,eligibility access /&>ds ,section     
#agjc;,b ( title #ch1 ,unit$ ,/ates     
,code1 is am5d$-- 7#a7 by /rik+         
subsections 7a7 ?r\gh 7e7 & ins]t+ !    
foll[+3  7a7 ,eligibility /&>ds = access
 to community c>e  7#a7 ,a cov]$ vet]an 
%all be eligible to elect to receive    
non-,dep>tm5t hospital c>e1 m$ical      
s]vices1 or ext5d$ c>e s]vices1 exclud+ 
nurs+ home c>e1 ?r\gh ! ,vet]ans        
,community ,c>e ,program "u section     
#agjc ( ?is title pursuant to subsection
 7d77#a77;,d7 ( su* section us+ ! foll[+
 eligibility access /&>ds3 7,a7 ,)      
respect to prim>y c>e1 m5tal heal? c>e1 
or ext5d$ c>e s]vices1 exclud+ nurs+    
home c>e1 if ! ,dep>tm5t _c s*$ule an   
9-p]son appo9tm5t = ! cov]$ vet]an ) a  
heal? c>e provid] ( ! ,dep>tm5t :o c    
provide ! ne$$ s]vice-- 7i7 )9 #cj      
m9utes av]age driv+ "t 7or su* %ort]    

av]age driv+ "t z ! ,secret>y may       
prescribe7 f ! resid5ce ( ! vet]an      
unless a long] av]age driv+ "t has be5  
agre$ to by ! vet]an 9 consultation ) a 
heal? c>e provid] ( ! vet]an2 &  7ii7 )9
 #bj days 7or su* %ort] p]iod z !       
,secret>y may prescribe7 ( ! date (     
reque/ = su* an appo9tm5t unless a lat] 
date has be5 agre$ to by ! vet]an 9     
consultation ) a heal? c>e provid] ( !  
vet]an4  7,b7 ,) respect to specialty   
c>e1 if ! ,dep>tm5t _c s*$ule an 9-p]son
 appo9tm5t = ! cov]$ vet]an ) a heal?   
c>e provid] ( ! ,dep>tm5t :o c provide !
 ne$$ s]vice-- 7i7 )9 #fj m9utes av]age 
driv+ "t 7or su* %ort] av]age driv+ "t z
 ! ,secret>y may prescribe7 f ! resid5ce
 ( ! vet]an unless a long] av]age driv+ 
"t has be5 agre$ to by ! vet]an 9       
consultation ) a heal? c>e provid] ( !  
vet]an2 &  7ii7 )9 #bh days 7or su*     
%ort] p]iod z ! ,secret>y may prescribe7
 ( ! date ( reque/ = su* an appo9tm5t   
unless a lat] date has be5 agre$ to by !
 vet]an 9 consultation ) a heal? c>e    

provid] ( ! vet]an4  7#b7 ,= ! purposes 
( det]m9+ ! eligibility ( a cov]$ vet]an
 = c>e or s]vices "u p>agraph 7#a71 !   
,secret>y %all n take into consid]ation 
! availability ( teleheal? appo9tm5ts f 
! ,dep>tm5t :5 det]m9+ :e!r ! ,dep>tm5t 
is able to furni% su* c>e or s]vices 9 a
 mann] t complies ) ! eligibility access
 /&>ds "u su* p>agraph4  7#c7 ,9 ! case 
( a cov]$ vet]an :o has _h an appo9tm5t 
) a heal? c>e provid] ( ! ,dep>tm5t     
cancel$ by ! ,dep>tm5t = a reason o!r   
?an ! reque/ ( ! vet]an1 9 calculat+ a  
wait "t = a subsequ5t appo9tm5t "u      
p>agraph 7#a71 ! ,secret>y %all         
calculate su* wait "t f ! date ( !      
reque/ = ! orig9al1 cancel$ appo9tm5t4  
7#d7 ,if a vet]an agrees to a long]     
av]age drive "t or a lat] date "u       
subp>agraph 7,a7 or 7,b7 ( p>agraph     
7#a71 ! ,secret>y %all docum5t !        
agreem5t to su* long] av]age drive "t or
 lat] date 9 ! electronic heal? record (
 ! vet]an & provide ! vet]an a copy (   
su* docum5tation4 ,su* copy may be      

provid$ electronically4  7b7            
,application ,! ,secret>y %all ensure t 
! eligibility access /&>ds e/abli%$ "u  
subsection 7a7 apply-- 7#a7 to all c>e &
 s]vices )9 ! m$ical b5efits package ( !
 ,dep>tm5t to :i* a cov]$ vet]an is     
eligible "u section #agjc ( ?is title1  
exclud+ nurs+ home c>e2 &  7#b7 to all  
cov]$ vet]ans1 reg>dless ( :e!r a vet]an
 is a new or e/abli%$ pati5t4  7c7      
,p]iodic review ( access /&>ds ,n lat]  
?an ?ree ye>s aft] ! date ( ! enactm5t (
 ! ,complete ! ,mission ,act ( #bjbd1 & 
n less frequ5tly ?an once e ?ree ye>s   
!reaft]1 ! ,secret>y %all-- 7#a7 conduct
 a review ( ! eligibility access /&>ds  
"u subsection 7a7 9 consultation )--    
7,a7 su* ,f$]al entities z ! ,secret>y  
consid]s appropriate1 includ+ !         
,dep>tm5t ( ,def5se1 ! ,dep>tm5t (      
,heal? & ,human ,s]vices1 & ! ,c5t]s =  
,m$ic>e  ,m$icaid ,s]vices2  7,b7       
entities & individuals 9 ! private      
sector1 includ+-- 7i7 vet]an pati5ts2   
7ii7 vet]ans s]vice organizations2 &    

7iii7 heal? c>e provid]s p>ticipat+ 9 ! 
,vet]ans ,community ,c>e ,program "u    
section #agjc ( ?is title2 &  7,c7 o!r  
entities t are n "p ( ! ,f$]al          
,gov]nm5t2 &  7#b7 submit to !          
appropriate committees ( ,congress a    
report on-- 7,a7 ! f9d+s ( ! ,secret>y )
 respect to ! review conduct$ "u        
p>agraph 7#a72 &  7,b7 su*              
recomm5dations z ! ,secret>y may h )    
respect to ! eligibility access /&>ds "u
 subsection 7a74  2  7#b7 by /rik+      
subsection 7g72  7#c7 by r$esignat+     
subsections 7f71 7h71 & 7i7 z           
subsections 7d71 7e71 & 7f71            
respectively2  7#d7 9 subsection 7d71 z 
r$esignat$ by p>agraph 7#c7-- 7,a7 by   
/rik+ e/abli%$ ea* place x appe>s2 &    
7,b7 9 p>agraph 7#a71 by /rik+ 7#a7     
,subject to & ins]t+ ,compliance by     
community c>e provid]s ) access         
/&>ds4--7#a7 ,subject to2  7#e7 9       
subsection 7e71 z s r$esignat$-- 7,a7 9 
p>agraph 7#a7-- 7i7 by /rik+ 7#a7       
,consi/5t ) & ins]t+ ,det]m9ation reg>d+

 eligibility4--7#a7 ,consi/5t )2 &  7ii7
 by /rik+ designat$ access /&>ds        
e/abli%$ "u ?is section & ins]t+        
eligibility access /&>ds "u subsection  
7a72 &  7,b7 9 p>agraph 7#b77;,b71 by   
/rik+ designat$ access /&>ds e/abli%$ "u
 ?is section & ins]t+ eligibility access
 /&>ds "u subsection 7a72 &  7#f7 9     
subsection 7f71 z r$esignat$ by p>agraph
 7#b7-- 7,a7 9 ! matt] prec$+ p>agraph  
7#a71 by /rik+ ,9 ?is section & ins]t+  
,def9itions4--,9 ?is section2 &  7,b7 9 
p>agraph 7#b7-- 7i7 by /rik+ cov]$      
vet]ans & ins]t+ cov]$ vet]an2 &  7ii7  
by /rik+ vet]ans describ$ & ins]t+ a    
vet]an describ$4  7b7 ,con=m+ am5dm5ts  
,section #agjc7;d7 ( su* title is       
am5d$-- 7#a7 9 p>agraph 7#a77;,d71 by   
/rik+ designat$ access /&>ds develop$ by
 ! ,secret>y "u section #agjc;,b ( ?is  
title & ins]t+ eligibility access /&>ds 
"u section #agjc;,b7a7 ( ?is title2 &   
7#b7 9 p>agraph 7#c71 by /rik+ designat$
 access /&>ds develop$ by ! ,secret>y "u
 section #agjc;,b ( ?is title & ins]t+  

eligibility access /&>ds "u section     
#agjc;,b7a7 ( ?is title4  #ajb4         
,requirem5t t ,secret>y notify vet]ans (
 eligibility = c>e "u ,vet]ans          
,community ,c>e ,program ,section       
#agjc7;a7 ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$ by add+ at ! end !      
foll[+ new p>agraph3  7#e7 7,a7 ,!      
,secret>y %all notify ea* cov]$ vet]an 9
 writ+ ( ! eligibility ( su* vet]an =   
c>e or s]vices "u ?is section z soon z  
possible1 b n lat] ?an two bus9ess days1
 aft] ! date on :i* a vet]an eligible = 
su* c>e or s]vices "u ?is section seeks 
c>e or s]vices4  7,b7 ,) respect to ea* 
cov]$ vet]an eligible = c>e or s]vices  
"u subsection 7d71 ! ,secret>y %all     
provide su* vet]an p]iodic rem9d]s1 z ! 
,secret>y det]m9es appropriate1 ( _!    
ongo+ eligibility "u su* subsection4    
7,c7 ,any notification or rem9d] "u ?is 
p>agraph may be provid$ electronically4 
4  #ajc4 ,consid]ation "u ,vet]ans      
,community ,c>e ,program ( vet]an       
pref]5ce = c>e & ne$ = c>egiv] or       

att5dant ,section #agjc7;d77#b7 ( title 
#ch1 ,unit$ ,/ates ,code1 is am5d$ by   
add+ at ! end ! foll[+ new subp>agraphs3
  7,f7 ,! pref]5ce ( ! cov]$ vet]an =   
:]e1 :51 & h[ to seek hospital c>e1     
m$ical s]vices1 or ext5d$ c>e s]vices4  
7,g7 ,:e!r ! cov]$ vet]an reque/s or    
requires ! assi/ance ( a c>egiv] or     
att5dant :5 seek+ hospital c>e1 m$ical  
s]vices1 or ext5d$ c>e s]vices4  4      
#ajd4 ,notification ( d5ial ( reque/ =  
c>e "u ,vet]ans ,community ,c>e ,program
 ,section #agjc ( title #ch1 ,unit$     
,/ates ,code1 is am5d$-- 7#a7 by        
r$esignat+ subsection 7o7 z subsection  
7p72 &  7#b7 by ins]t+ aft] subsection  
7n7 ! foll[+ new subsection 7o73  7o7   
,notification ( d5ial ( reque/ = c>e &  
h[ ,to appeal  7#a7 ,if a reque/ by a   
vet]an = c>e or s]vices "u ?is section  
is d5i$1 ! ,secret>y %all notify !      
vet]an 9 writ+ z soon z possible1 b n   
lat] ?an two bus9ess days1 aft] ! d5ial 
is made-- 7,a7 ( ! reason = ! d5ial2 &  
7,b7 ) in/ructions on h[ to appeal su*  

d5ial us+ ! cl9ical appeals process ( ! 
,vet]ans ,heal? ,adm9i/ration4  7#b7 ,if
 a d5ial "u p>agraph 7#a7 is due to n   
meet+ ! eligibility access /&>ds "u     
section #agjc;,b7a7 ( ?is title1 notice 
"u su* p>agraph %all include an         
explanation = :y ! ,secret>y does n     
consid] ! vet]an to h met su* /&>ds4    
7#c7 ,any notification "u ?is subsection
 may be provid$ electronically4  4      
#aje4 ,discussion ( teleheal? options "u
 ,vet]ans ,community ,c>e ,program      
,section #agjc ( title #ch1 ,unit$      
,/ates ,code1 z am5d$ by section #ajd1  
is fur!r am5d$-- 7#a7 by r$esignat+     
subsection 7p7 z subsection 7q72 &  7#b7
 by ins]t+ aft] subsection 7o7 ! foll[+ 
new subsection 7p73  7p7 ,discussion (  
options = teleheal? ,:5 discuss+ options
 = c>e or s]vices = a cov]$ vet]an "u   
?is section1 ! ,secret>y %all ensure t !
 vet]an is in=m$ ( ! ability ( ! vet]an 
to seek c>e or s]vices via teleheal?1   
ei!r ?r\gh a m$ical facility ( !        
,dep>tm5t or "u ?is section1 if         

teleheal?-- 7#a7 is available to !      
vet]an2  7#b7 is appropriate = ! type ( 
c>e or s]vices ! vet]an is seek+1 z     
det]m9$ by ! ,secret>y2 &  7#c7 is      
acceptable to ! vet]an4  4  #ajf4 ,use (
 value-bas$ reimbursem5t models "u      
,vet]ans ,community ,c>e ,program  7a7  
,9 g5]al ,section #agjc7;i77#e7 ( title 
#ch1 ,unit$ ,/ates ,code1 is am5d$ by   
/rik+ may & ins]t+ %all4  7b7           
,negotiation ( t]ms ,! ,secret>y (      
,vet]ans ,affairs %all negotiate ) ,?ird
 ,p>ty ,adm9i/rators to e/abli% ! use ( 
value-bas$ reimbursem5t models "u !     
,vet]ans ,community ,c>e ,program "u    
section #agjc ( title #ch1 ,unit$ ,/ates
 ,code1 pursuant to ! am5dm5t made by   
subsection 7a74  7c7 ,report on         
value-,bas$ reimbursem5t models ,n lat] 
?an "o ye> aft] negotiat+ "u subsection 
7b7 t]ms to e/abli% ! use ( value-bas$  
reimbursem5t models "u ! ,vet]ans       
,community ,c>e ,program "u section     
#agjc ( title #ch1 ,unit$ ,/ates ,code1 
! ,secret>y1 9 consultation ) ! ,c5t] = 

,innovation = ,c>e & ,paym5t ( !        
,dep>tm5t ( ,vet]ans ,affairs "u section
 #agjc;,e ( title #ch1 ,unit$ ,/ates    
,code1 & ! ,(fice ( ,integrat$ ,vet]an  
,c>e ( ! ,dep>tm5t1 or successor (fice1 
%all submit to ! ,committee on ,vet]ans'
 ,affairs ( ! ,s5ate & ! ,committee on  
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report conta9+-- 7#a7 
an assessm5t ( ! ef=ts ( ! ,dep>tm5t    
pursuant to section #agjc7;i77#e7 ( su* 
title1 z am5d$ by subsection 7a71 to    
incorporate value-bas$ reimbursem5t     
models to promote ! provision (         
high-quality c>e to vet]ans2 &  7#b7 su*
 recomm5dations = legislative or        
adm9i/rative action z ! ,secret>y       
consid]s appropriate to increase ! use (
 value-bas$ reimbursem5t models ?r\gh\t 
! ,vet]ans ,community ,c>e ,program "u  
section #agjc ( su* title4  7d7 ,rule ( 
con/ruction ,?is section %all n be      
con/ru$ to be a pilot program subject to
 ! requirem5ts ( section #agjc;,e (     
title #ch1 ,unit$ ,/ates ,code4  7e7    

,?ird ,p>ty ,adm9i/rator def9$ ,9 ?is   
section1 ! t]m ,?ird ,p>ty ,adm9i/rator 
means an entity t manages a provid]     
network & p]=ms adm9i/rative s]vices    
relat$ to su* network "u section #agjc (
 title #ch1 ,unit$ ,/ates ,code4  #ajg4 
,ext5sion ( deadl9e = submittal ( claims
 by heal? c>e entities & provid]s "u    
prompt paym5t /&>d ,section #agjc;,d7b7 
( title #ch1 ,unit$ ,/ates ,code1 is    
am5d$ by /rik+ #ahj days & ins]t+ "o    
ye>4  ,,ii ,o!r ,heal? ,c>e ,matt]s     
#bja4 ,plan on e/abli%m5t ( int]active1 
onl9e self-s]vice module = c>e  7a7 ,9  
g5]al ,! ,secret>y ( ,vet]ans ,affairs1 
work+ ) ,?ird ,p>ty ,adm9i/rators & act+
 ?r\gh ! ,c5t] = ,innovation = ,c>e &   
,paym5t ( ! ,dep>tm5t ( ,vet]ans        
,affairs "u section #agjc;,e ( title    
#ch1 ,unit$ ,/ates ,code1 %all develop &
 implem5t a plan to e/abli% an          
int]active1 onl9e self-s]vice module--  
7#a7 to all[ vet]ans to reque/          
appo9tm5ts1 track ref]rals = heal? c>e  
"u ! laws adm9i/]$ by ! ,secret>y1 :e!r 

at a facility ( ! ,dep>tm5t or ?r\gh a  
non-,dep>tm5t provid]1 & receive        
appo9tm5t rem9d]s2  7#b7 to all[ vet]ans
 to appeal & track decisions relat+ to--
 7,a7 d5ials ( reque/s = c>e or s]vices 
"u section #agjc ( title #ch1 ,unit$    
,/ates ,code2 or  7,b7 d5ials ( reque/s 
= c>e or s]vices at facilities ( !      
,dep>tm5t1 includ+ "u section #agaj (   
su* title2 &  7#c7 to implem5t su* o!r  
matt]s z det]m9$ appropriate by !       
,secret>y 9 consultation ) ,?ird ,p>ty  
,adm9i/rators4  7b7 ,submittal ( plan   
7#a7 ,initial plan ,n lat] ?an #ahj days
 aft] ! date ( ! enactm5t ( ?is ,act1 ! 
,secret>y %all submit to ! ,committee on
 ,vet]ans' ,affairs ( ! ,s5ate & !      
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives ! plan develop$ 
"u subsection 7a74  7#b7 ,qu>t]ly update
 ,n less frequ5tly ?an qu>t]ly foll[+ ! 
submittal ( ! plan "u p>agraph 7#a7 & = 
two ye>s !reaft]1 ! ,secret>y %all      
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ! ,committee on   

,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report conta9+ any    
updates on ! implem5tation ( su* plan4  
7c7 ,rule ( con/ruction ,?is section    
%all n be con/ru$ to be a pilot program 
subject to ! requirem5ts ( section      
#agjc;,e ( title #ch1 ,unit$ ,/ates     
,code4  7d7 ,?ird ,p>ty ,adm9i/rator    
def9$ ,9 ?is section1 ! t]m ,?ird ,p>ty 
,adm9i/rator means an entity t manages a
 provid] network & p]=ms adm9i/rative   
s]vices relat$ to su* network "u section
 #agjc ( title #ch1 ,unit$ ,/ates ,code4
  #bjb4 ,publication ( wait times = c>e 
at m$ical c5t]s ( ,dep>tm5t ( ,vet]ans  
,affairs  7a7 ,9 g5]al ,sub*apt] ,i (   
*apt] #ag ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$ by ins]t+ aft] section  
#agjc;,f ! foll[+ new section3          
#agjc;,g4 ,publication ( wait times =   
c>e at m$ical c5t]s  7a7 ,9 g5]al ,!    
,secret>y %all publi% on a publicly     
available int]net website ( ! ,dep>tm5t 
! av]age wait "t = a vet]an to s*$ule an
 appo9tm5t at ea* m$ical c5t] ( !       

,dep>tm5t = ! receipt ( prim>y c>e1     
specialty c>e1 & m5tal heal? c>e measur$
 f ! date ( reque/ = ! appo9tm5t to !   
date on :i* ! c>e 0 provid$4  7b7       
,update ,! ,secret>y %all update ! wait 
times publi%$ "u subsection 7a7 n less  
frequ5tly ?an mon?ly4  4  7b7 ,cl]ical  
am5dm5t ,! table ( sections at ! beg9n+ 
( su* sub*apt] is am5d$ by ins]t+ aft] !
 item relat+ to section #agjc;,f !      
foll[+ new item3  #agjc;,g4 ,publication
 ( wait times = c>e at m$ical c5t]s4  4 
#bjc4 ,modification ( requirem5ts =     
,c5t] = ,innovation = ,c>e & ,paym5t ( !
 ,dep>tm5t ( ,vet]ans ,affairs &        
requirem5t = pilot program  7a7 ,9 g5]al
 ,section #agjc;,e ( title #ch1 ,unit$  
,/ates ,code1 is am5d$-- 7#a7 9         
subsection 7a7-- 7,a7 9 p>agraph 7#a71  
by /rik+ )9 ! ,dep>tm5t & ins]t+ )9 !   
,(fice ( ! ,secret>y2  7,b7 9 p>agraph  
7#b71 by /rik+ may & ins]t+ %all2 &     
7,c7 9 p>agraph 7#c7-- 7i7 9 subp>agraph
 7,a71 by /rik+ 2 & & ins]t+ a          
semicolon2  7ii7 9 subp>agraph 7,b71 by 

/rik+ ! p]iod at ! end & ins]t+ 2 or2 & 
7iii7 by add+ at ! end ! foll[+ new     
subp>agraph3  7,c7 increase             
productivity1 effici5cy1 & mod]nization 
?r\gh\t ! ,dep>tm5t4  2  7#b7 by /rik+  
subsection 7d7 & ins]t+ ! foll[+ new    
subsection 7d73  7d7 ,budget>y l9e item 
,! ,secret>y %all include 9 ! budget    
ju/ification mat]ials submitt$ to       
,congress 9 support ( ! budget ( !      
,dep>tm5t ( ,vet]ans ,affairs = a fiscal
 ye> 7z submitt$ ) ! budget ( !         
,presid5t "u section #aaje7;a7 ( title  
#ca7 specific id5tification1 z a        
budget>y l9e item1 ( ! am\nts requir$ to
 c>ry out ?is section4  2  7#c7 9       
subsection 7f7-- 7,a7 9 p>agraph 7#a71  
by /rik+ 9 sub*apt]s ,i1 ,,ii1 & ,,iii (
 ?is *apt] & ins]t+ ( ?is title1 ( title
 #ch1 ,code ( ,f$]al ,regulations1 & (  
any h&books1 directives1 or policy      
docum5ts ( ! ,dep>tm5t2 &  7,b7 9       
p>agraph 7#b71 9 ! matt] prec$+         
subp>agraph 7,a71 by /rik+ waiv+ any    
au?ority & ins]t+ waiv+ any provision ( 

?is title2  7#d7 9 subsection 7g77#a71  
by ins]t+ few] ?an ?ree or be=e m ?an   
#aj2  7#e7 9 subsection 7i7-- 7,a7 9    
p>agraph 7#a71 by /rik+ ! ,"u ,secret>y 
= ,heal? & ! ,special ,m$ical ,advisory 
,gr\p e/abli%$ pursuant to section #gcab
 ( ?is title & ins]t+ ! ,"u ,secret>y = 
,heal?1 ! ,special ,m$ical ,advisory    
,gr\p e/abli%$ pursuant to section #gcab
 ( ?is title1 ! ,(fice ( ,integrat$     
,vet]an ,c>e 7or successor (fice71 !    
,(fice ( ,f9ance 7or successor (fice71 !
 ,vet]an ,exp]i5ce ,(fice 7or successor 
(fice71 ! ,(fice ( ,ent]prise           
,integration 7or successor (fice71 & !  
,(fice ( ,in=mation & ,te*nology 7or    
successor (fice72 &  7,b7 9 p>agraph    
7#b71 by /rik+ repres5tatives ( relevant
 ,f$]al ag5cies1 & cl9ical & analytical 
exp]ts ) exp]tise 9 m$ic9e & heal? c>e  
managem5t & ins]t+ repres5tatives (     
relevant ,f$]al ag5cies1 nonpr(it       
organizations1 & o!r public & private   
sector entities1 includ+ ^? ) cl9ical & 
analytical exp]ts ) exp]tise 9 m$ic9e & 

heal? c>e managem5t2 &  7#f7 by add+ at 
! end ! foll[+ new subsection3  7k7     
,report on activities ( ,c5t] =         
,innovation = ,c>e & ,paym5t ,n less    
frequ5tly ?an annually1 ! ,secret>y %all
 submit to ,congress a report t conta9s1
 = ! "o-ye> p]iod prec$+ ! date ( !     
report-- 7#a7 a full acc\nt+ ( !        
activities1 /aff1 budget1 & o!r res\rces
 & ef=ts ( ! ,c5t]2 &  7#b7 an assessm5t
 ( ! outcomes ( ! ef=ts ( ! ,c5t]4  4   
7b7 ,comptroll] ,g5]al ,report ,n lat]  
?an #ah mon?s aft] ! date ( ! enactm5t (
 ?is ,act1 ! ,comptroll] ,g5]al ( !     
,unit$ ,/ates %all submit to ,congress a
 report-- 7#a7 on ! ef=ts ( ! ,c5t] =   
,innovation = ,c>e & ,paym5t ( !        
,dep>tm5t ( ,vet]ans ,affairs 9 fulfill+
 ! objectives & requirem5ts "u section  
#agjc;,e ( title #ch1 ,unit$ ,/ates     
,code1 z am5d$ by subsection 7a72 &     
7#b7 conta9+ su* recomm5dations z !     
,comptroll] ,g5]al consid]s appropriate4
  7c7 ,pilot program  7#a7 ,9 g5]al ,n  
lat] ?an "o ye> aft] ! date ( ! enactm5t

 ( ?is ,act1 ! ,c5t] = ,innovation =    
,c>e & ,paym5t ( ! ,dep>tm5t ( ,vet]ans 
,affairs "u section #agjc;,e ( title    
#ch1 ,unit$ ,/ates ,code1 %all e/abli% a
 ?ree-ye> pilot program 9 n few] ?an    
five locations to all[ vet]ans enroll$ 9
 ! sy/em ( annual pati5t enrollm5t ( !  
,dep>tm5t e/abli%$ & op]at$ "u section  
#agje7;a7 ( su* title to access         
outpati5t m5tal heal? & sub/ance use    
s]vices ?r\gh heal? c>e provid]s        
specifi$ "u section #agjc7;c7 ( su*     
title )\t ref]ral or pre-au?orization4  
7#b7 ,priority ,9 select+ sites = !     
pilot program "u p>agraph 7#a71 !       
,secret>y %all prioritize sites 9 !     
foll[+ areas3 7,a7 ,areas ) v>y+ degrees
 ( urbanization1 includ+ urban1 rural1 &
 highly rural areas4  7,b7 ,areas ) high
 rates ( suicide among vet]ans4  7,c7   
,areas ) high rates ( ov]dose dea?s     
among vet]ans4  7,d7 ,areas ) high rates
 ( calls to ! ,vet]ans ,crisis ,l9e4    
7,e7 ,areas ) long wait times = m5tal   
heal? & sub/ance use s]vices at         

facilities ( ! ,dep>tm5t4  7,f7 ,areas )
 outpati5t m5tal heal? & sub/ance use   
programs t utilize a value-bas$ c>e     
model1 to ! ext5t practicable4  7#c7    
,elem5ts ,! ,secret>y1 9 implem5t+ !    
pilot program "u p>agraph 7#a71 %all    
ensure ! ,dep>tm5t has a c>e coord9ation
 sy/em 9 place t includes-- 7,a7 k %>+1 
includ+ ! timely ex*ange ( m$ical       
docum5tation2  7,b7 assi/ance )         
transitions ( c>e1 includ+ ! pot5tial   
ne$ = inpati5t or resid5tial psy*iatric 
s]vices1 sub/ance use detoxification    
s]vices1 po/-detoxification /ep-d[n     
s]vices1 & resid5tial rehabilitation    
programs2  7,c7 cont9u\s assessm5t (    
pati5t ne$s & goals2 &  7,d7 creat+     
p]sonaliz$1 proactive c>e plans4  7#d7  
,ov]sight & outcomes ,! ,secret>y %all  
develop appropriate metrics & measures--
 7,a7 to track & ov]see sites at :i* !  
pilot program "u p>agraph 7#a7 is c>ri$ 
out2  7,b7 to monitor pati5t safety &   
outcomes "u ! pilot program2 &  7,c7 to 
assess & mitigate any b>ri]s to ext5d+ !

 pilot program across ! entire ,vet]ans 
,heal? ,adm9i/ration4  7#e7 ,annual     
report  7,a7 ,9 g5]al ,n lat] ?an "o ye>
 aft] ! comm5cem5t ( ! pilot program "u 
p>agraph 7#a71 & n less frequ5tly ?an   
annually !reaft] dur+ ! duration ( !    
pilot program1 ! ,secret>y %all submit  
to ! ,committee on ,vet]ans' ,affairs ( 
! ,s5ate & ,committee on ,vet]ans'      
,affairs ( ! ,h\se ( ,repres5tatives a  
report on ! pilot program1 :i* %all     
include ! foll[+3 7i7 ,! numb] ( unique 
vet]ans :o p>ticipat$ 9 ! pilot program4
  7ii7 ,! numb] ( heal? c>e provid]s :o 
p>ticipat$ 9 ! pilot program4  7iii7 ,an
 assessm5t ( ! effectiv5ess ( ! pilot   
program 9 increas+ access to1 & improv+ 
outcomes =1 m5tal heal? & sub/ance use  
treatm5t s]vices4  7iv7 ,! co/ ( ! pilot
 program4  7v7 ,su* o!r matt]s z !      
,secret>y consid]s appropriate4  7,b7   
,f9al report ,! ,secret>y %all include 9
 ! f9al report submitt$ "u subp>agraph  
7,a71 9 addition to ! requirem5ts "u su*
 subp>agraph1 ! assessm5t by ! ,secret>y

 ( ! feasibility & advisability ( ext5d+
 ! pilot program across ! entire        
,vet]ans ,heal? ,adm9i/ration1 includ+ a
 plan1 timel9e1 & requir$ res\rces = su*
 an ext5sion4  7#f7 ,vet]ans crisis l9e 
def9$ ,9 ?is subsection1 ! t]m ,vet]ans 
,crisis ,l9e means ! toll-free hotl9e = 
vet]ans e/abli%$ "u section #agbj;,f7h7 
( title #ch1 ,unit$ ,/ates ,code4  #bjd4
 ,/&>diz$ process to det]m9e eligibility
 ( cov]$ vet]ans = p>ticipation 9 c]ta9 
m5tal heal? treatm5t programs  7a7      
,/&>diz$ scre5+ process ,n lat] ?an "o  
ye> aft] ! date ( ! enactm5t ( ?is ,act1
 ! ,secret>y ( ,vet]ans ,affairs %all   
e/abli% a /&>diz$ scre5+ process to     
det]m9e1 bas$ on cl9ical ne$1 :e!r a    
cov]$ vet]an satisfies crit]ia =        
priority or r\t9e admission to a cov]$  
treatm5t program4  7b7 ,eligibility     
crit]ia  7#a7 ,9 g5]al ,"u ! /&>diz$    
scre5+ process requir$ by subsection    
7a71 a cov]$ vet]an %all be eligible =  
priority admission to a cov]$ treatm5t  
program if ! cov]$ vet]an meets crit]ia 

t include1 b are n limit$ to1 ! foll[+3 
7,a7 ,symptoms t-- 7i7 significantly    
affect activities ( daily life2 &  7ii7 
increase ! risk ( su* vet]an = adv]se   
outcomes4  7,b7 ,an unsafe liv+         
situation4  7,c7 ,a high-risk flag =    
suicide4  7,d7 ,a det]m9ation ( be+ a   
high risk = suicide4  7,e7 ,risk factors
 = ov]dose4  7,f7 ,non-responsive1      
relaps$1 or unable to f9d recov]y f "o  
o!r c\rse ( treatm5t1 su* z outpati5t or
 int5sive outpati5t treatm5t4  7,g7 ,o!r
 su* crit]ia z ! ,secret>y det]m9es     
appropriate4  7#b7 ,consid]ation ,9 mak+
 a det]m9ation "u p>agraph 7#a71 !      
,secret>y %all consid] any ref]ral ( a  
heal? c>e provid] ( a cov]$ vet]an = su*
 cov]$ vet]an to be admitt$ to a cov]$  
treatm5t program4  7c7 ,"t = scre5+ &   
admission ,"u ! /&>diz$ scre5+ process  
requir$ by subsection 7a71 ! ,secret>y  
%all ensure a cov]$ vet]an-- 7#a7 is    
scre5$ n lat] ?an #dh h\rs aft] ! date  
on :i* ! cov]$ vet]an1 or a relevant    
heal? c>e provid]1 makes a reque/ = !   

cov]$ vet]an to be admitt$ to a cov]$   
treatm5t program2 &  7#b7 det]m9$       
eligible = priority admission to a cov]$
 treatm5t program is admitt$ to su*     
cov]$ treatm5t program n lat] ?an #dh   
h\rs aft] ! date ( su* det]m9ation4  7d7
 ,access /&>ds = r\t9e admission ,!     
,secret>y %all include ! /&>diz$ scre5+ 
process "u ?is section 9 ! wait "t      
access /&>ds = eligibility = m5tal heal?
 c>e "u section #agjc7;d7 ( su* title   
e/abli%$ by ! ,secret>y "u section      
#agjc;,b ( su* title4  7e7 ,conditions  
"u :i* c>e %all be furni%$ ?r\gh        
non-,dep>tm5t provid]s ,if ! ,secret>y  
det]m9es a cov]$ vet]an to be eligible =
 ei!r priority or r\t9e admission to a  
cov]$ treatm5t program pursuant to !    
/&>diz$ scre5+ process requir$ by       
subsection 7a71 & ! ,secret>y is unable 
to admit su* cov]$ vet]an to a cl9ically
 necess>y cov]$ treatm5t program at a   
facility ( ! ,dep>tm5t ( ,vet]ans       
,affairs )9 #cj m9utes av]age driv+ "t  
7or su* %ort] p]iod z ! ,secret>y may   

prescribe7 ( ! vet]an's resid5ce2 & )9  
#bj days 7or su* %ort] p]iod z !        
,secret>y may prescribe7 ( ! date (     
reque/ = vet]ans eligible = r\t9e       
admission1 or )9 #dh h\rs 7or su* %ort] 
p]iod z ! ,secret>y may prescribe7 =    
vet]ans deem$ eligible = priority       
admission unless a lat] date has be5    
agre$ to by ! vet]an 9 consultation ) _!
 ,dep>tm5t heal? c>e provid]4  7f7      
,def9itions ,9 ?is section3 7#a7 ,! t]m 
cov]$ treatm5t program-- 7,a7 means a   
m5tal heal? resid5tial rehabilitation   
treatm5t program ( ! ,dep>tm5t (        
,vet]ans ,affairs2  7,b7 a program ( !  
,dep>tm5t = resid5tial c>e = m5tal heal?
 & sub/ance abuse disord]s2  7,c7       
includes-- 7i7 ! programs designat$ z ( 
! date ( ! enactm5t ( ?is section z     
domicili>y resid5tial rehabilitation    
treatm5t programs2 &  7ii7 any programs 
designat$ z domicili>y resid5tial       
rehabilitation treatm5t programs on or  
aft] su* date ( enactm5t2 &  7,d7 does n
 include ,comp5sat$ ,"w ,!rapy          

,transition ,resid5ce programs ( !      
,dep>tm5t4  7#b7 ,! t]m cov]$ vet]an    
means a vet]an describ$ 9 section       
#agjc7;b7 ( title #ch1 ,unit$ ,/ates    
,code4  #bje4 ,reports  7a7 ,report on  
improvem5ts to cl9ical appeals process  
,n lat] ?an "o ye> aft] ! date ( !      
enactm5t ( ?is ,act1 & n less frequ5tly 
?an once e ?ree ye>s !reaft]1 !         
,secret>y ( ,vet]ans ,affairs1 9        
consultation ) vet]ans s]vice           
organizations1 vet]ans1 c>egiv]s (      
vet]ans1 employees ( ! ,dep>tm5t (      
,vet]ans ,affairs1 & o!r /akehold]s z   
det]m9$ by ! ,secret>y1 %all submit to !
 ,committee on ,vet]ans' ,affairs ( !   
,s5ate & ,committee on ,vet]ans'        
,affairs ( ! ,h\se ( ,repres5tatives a  
report conta9+ recomm5dations =         
legislative or adm9i/rative action to   
improve ! cl9ical appeals process ( !   
,dep>tm5t ) respect to timel9ess1       
transp>5cy1 objectivity1 consi/5cy1 &   
fairness4  7b7 ,report on requir$ c>e & 
s]vices "u community c>e program ,n lat]

 ?an "o ye> aft] ! date ( ! enactm5t (  
?is ,act1 & n less frequ5tly ?an        
annually !reaft]1 ! ,secret>y %all      
submit to ! ,committee on ,vet]ans'     
,affairs ( ! ,s5ate & ,committee on     
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives a report t conta9s1 = ! 
"o-ye> p]iod prec$+ ! date ( ! report1 !
 foll[+3 7#a7 ,! numb] ( vet]ans        
eligible = c>e or s]vices "u section    
#agjc ( title #ch1 ,unit$ ,/ates ,code1 
& ! reasons = su* eligibility1 includ+  
multiple su* reasons = vet]ans eligible 
"u m ?an "o eligibility crit]ia4  7#b7  
,! numb] ( vet]ans :o opt to seek c>e or
 s]vices "u su* section4  7#c7 ,! numb] 
( vet]ans :o d n opt to seek c>e or     
s]vices "u su* section4  7#d7 ,an       
assessm5t ( ! timel9ess ( ref]rals = c>e
 or s]vices "u su* section4  7#e7 ,!    
numb] ( times a vet]an did n %[ = an    
appo9tm5t = c>e or s]vices "u su*       
section4  7#f7 ,! numb] ( reque/s = an  
appeal ( a d5ial ( c>e or s]vices "u su*
 section us+ ! cl9ical appeals process (

 ! ,vet]ans ,heal? ,adm9i/ration4  7#g7 
,! timel9ess ( ea* su* appeal4  7#h7 ,! 
outcome ( ea* su* appeal4  7c7 ,vet]ans 
s]vice organization def9$ ,9 ?is        
section1 ! t]m vet]ans s]vice           
organization means any organization     
recogniz$ by ! ,secret>y "u section     
#eijb ( title #ch1 ,unit$ ,/ates ,code4