,,ii  #aah? ,,congress  #a/ ,session    
,s4 #acae  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,april #bf1 #bjbc,mr4  
,moran 7= himself & ,ms4 ,s9ema7        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & 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 ! ,vet]ans' ,heal? ,emp[]m5t1 
,access1 ,lead]%ip1 & ,transp>5cy = our 
,h]oes 7,,heal?7 ,act ( #bjbc4  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 ,f9ality ( decision by vet]an &  
vet]an's ref]r+ provid]4,sec4 #ajg4     
,outrea* reg>d+ c>e & s]vices "u        
,vet]ans ,community ,c>e ,program4,sec4 
#ajh4 ,plan to improve adm9i/ration (   
c>e "u ,vet]ans ,community ,c>e         
,program4,sec4 #aji4 ,use ( value-bas$  
reimbursem5t models "u ,vet]ans         
,community ,c>e ,program4,sec4 #aaj4    
,ext5sion ( deadl9e = submittal ( claims
 by heal? c>e entities & provid]s "u    
prompt paym5t /&>d4,sec4 #aaa4          
,inspector ,g5]al assessm5t (           
implem5tation ( ,vet]ans ,community ,c>e
 ,program4,,title ,,ii--,o!r heal? c>e  
matters,sec4 #bja4 ,/rategic plan on    
transition ( ,vet]ans ,heal?            

,adm9i/ration to value-bas$ heal? c>e   
model4,sec4 #bjb4 ,plan on e/abli%m5t ( 
int]active1 onl9e self-s]vice module =  
c>e4,sec4 #bjc4 ,publication ( wait     
times = c>e at m$ical c5t]s ( ,dep>tm5t 
( ,vet]ans ,affairs4,sec4 #bjd4         
,docum5tation ( pref]5ces ( vet]ans =   
s*$ul+ ( appo9tm5ts = c>e4,sec4 #bje4   
,/aff+ model & p]=mance metrics = c]ta9 
employees ( ! ,dep>tm5t ( ,vet]ans      
,affairs4,sec4 #bjf4 ,modification (    
requirem5ts = ,c5t] = ,innovation = ,c>e
 & ,paym5t ( ! ,dep>tm5t ( ,vet]ans     
,affairs & requirem5t = pilot           
program4,sec4 #bjg4 ,onl9e heal?        
education portal = vet]ans enroll$ 9    
pati5t enrollm5t sy/em ( ,dep>tm5t (    
,vet]ans ,affairs4,sec4 #bjh4 ,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*$ule an   
appo9tm5t = ! cov]$ 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*$ule 
an appo9tm5t = ! cov]$ 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 (
 ! ,vet]ans' ,heal? ,emp[]m5t1 ,access1 
,lead]%ip1 & ,transp>5cy = our ,h]oes   
7,,heal?7 ,act ( #bjbc1 & 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* ! ,secret>y is aw>e 
t ! vet]an is seek+ c>e or s]vices & is 
eligible = su* c>e or s]vices "u ?is    
section4  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       

,f9ality ( decision by vet]an & vet]an's
 ref]r+ provid]  7a7 ,9 g5]al ,section  
#agjc ( title #ch1 ,unit$ ,/ates ,code1 
z am5d$ by sections #ajd & #aje1 is     
fur!r am5d$-- 7#a7 by r$esignat+        
subsection 7q7 z subsection 7r72 &  7#b7
 by ins]t+ aft] subsection 7p7 ! foll[+ 
new subsection 7q73  7q7 ,f9ality (     
decision by vet]an & ref]r+ provid] ,an 
agreem5t by a cov]$ vet]an & ! cov]$    
vet]an's ref]r+ provid] "u ?is section  
reg>d+ ! be/ m$ical int]e/ ( ! cov]$    
vet]an or reg>d+ eligibility = c>e or   
s]vices "u ?is section1 includ+ an      
agreem5t "u subsection 7d77#a77;,e71 is 
f9al & may n be *ang$ by ! ,dep>tm5t )\t
 ! k & cons5t1 docum5t$ 9 writ+1 ( !    
cov]$ vet]an & ! provid] unless !re is a
 /atutory or regulatory b>ri] prev5t+ ! 
,dep>tm5t f provid+ ! c>e or s]vices 9  
"q4  4  7b7 ,con=m+ am5dm5t ,section    
#agjc7;d77#a77;,e7 ( title #ch1 ,unit$  
,/ates ,code1 is am5d$ by /rik+ ref]r+  
cl9ician & ins]t+ ref]r+ provid]4  #ajg4
 ,outrea* reg>d+ c>e & s]vices "u       

,vet]ans ,community ,c>e ,program  7a7  
,9 g5]al ,section #agjc ( title #ch1    
,unit$ ,/ates ,code1 z am5d$ by sections
 #ajd1 #aje1 & #ajf1 is fur!r am5d$--   
7#a7 by r$esignat+ subsection 7r7 z     
subsection 7s72 &  7#b7 by ins]t+ aft]  
subsection 7q7 ! foll[+ new subsection  
7r73  7r7 ,outrea* reg>d+ availability (
 c>e & s]vices  7#a7 ,! ,secret>y %all--
 7,a7 conduct public outrea* to in=m    
vet]ans (-- 7i7 ! conditions =          
eligibility = c>e or s]vices "u         
subsections 7d7 & 7e72  7ii7 h[ to      
reque/ su* c>e or s]vices2 &  7iii7 h[  
to appeal a d5ial ( a reque/ = su* c>e  
or s]vices us+ ! cl9ical appeals process
 ( ! ,vet]ans ,heal? ,adm9i/ration2 &   
7,b7 ensure t in=mation ab\t eligibility
 = c>e or s]vices "u subsections 7d7 &  
7e7 is prom95tly display$ on ! website (
 ! ,dep>tm5t & includ$ 9 o!r outrea*    
campaigns & activities conduct$ by !    
,secret>y4  7#b7 ,^u enrollm5t ( a      
vet]an 9 ! sy/em ( annual pati5t        
enrollm5t e/abli%$ & op]at$ "u section  

#agje ( ?is title1 & n less frequ5tly   
?an e two ye>s !reaft]1 ! ,secret>y %all
 directly in=m ! vet]an (-- 7,a7 !      
conditions = eligibility = c>e or       
s]vices "u subsections 7d7 & 7e72  7,b7 
h[ to reque/ su* c>e or s]vices2 &  7,c7
 h[ to appeal a d5ial ( a reque/ = su*  
c>e or s]vices us+ ! cl9ical appeals    
process ( ! ,vet]ans ,heal?             
,adm9i/ration4  7#c7 ,! ,secret>y %all  
ensure t ea* m$ical facility ( !        
,dep>tm5t publicly displays in=mation   
reg>d+-- 7,a7 ! conditions = eligibility
 ( vet]ans = c>e or s]vices "u          
subsections 7d7 & 7e72  7,b7 h[ to      
reque/ su* c>e or s]vices2 &  7,c7 h[ to
 appeal a d5ial ( a reque/ = su* c>e or 
s]vices us+ ! cl9ical appeals process ( 
! ,vet]ans ,heal? ,adm9i/ration4  4  7b7
 ,transitional s]vices ^u sep>ation f   
arm$ =ces ,section #aadd7;f77#a77;,b77i7
 ( title #aj1 ,unit$ ,/ates ,code1 is   
am5d$ by ins]t+ 1 includ+ h[ to enroll 9
 ! sy/em ( annual pati5t enrollm5t      
e/abli%$ & op]at$ "u section #agje (    

title #ch1 ! ability to seek c>e &      
s]vices "u sections #agjc & #agaj ( su* 
title be=e ! semicolon4  7c7 ,solid ,/>t
 program ,section #fcbj7;a77#b77;,a7 (  
title #ch1 ,unit$ ,/ates ,code1 is am5d$
 by ins]t+ 1 includ+ h[ to enroll 9 !   
sy/em ( annual pati5t enrollm5t e/abli%$
 & op]at$ "u section #agje ( ?is title &
 ! ability to seek c>e & s]vices "u     
sections #agjc & #agaj ( ?is title be=e 
! semicolon4  7d7 ,comptroll] ,g5]al    
report on outrea* ,n lat] ?an two ye>s  
aft] ! date ( ! enactm5t ( ?is ,act1 !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates    
%all submit to ,congress a report on !  
ef=ts ( ! ,dep>tm5t ( ,vet]ans ,affairs 
to ensure t vet]ans are in=m$ ( !       
conditions = eligibility = c>e & s]vices
 "u section #agjc ( title #ch1 ,unit$   
,/ates ,code1 includ+ outrea* conduct$  
"u subsection 7r7 ( su* section1 z add$ 
by subsection 7a7 ( ?is section4  #ajh4 
,plan to improve adm9i/ration ( c>e "u  
,vet]ans ,community ,c>e ,program  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-- 
7#a7 to provide monet>y & non-monet>y   
inc5tives to heal? c>e provid]s specifi$
 9 subsection 7c7 ( section #agjc (     
title #ch1 ,unit$ ,/ates ,code1 furni%+ 
c>e or s]vices "u ! ,vet]ans ,community 
,c>e ,program "u su* section pursuant to
 an agreem5t ) a ,?ird ,p>ty            
,adm9i/rator-- 7,a7 to all[ ! ,secret>y 
& ,?ird ,p>ty ,adm9i/rators to see !    
s*$ul+ sy/em ( ! provid] = purposes (   
assess+ availability & assi/+ ) s*$ul+  
appo9tm5ts = vet]ans "u su* program1    
includ+ ?r\gh syn*ron\s1 asyn*ron\s1 &  
asyn*ron\s assi/$ digital s*$ul+2  7,b7 
to complete tra9+ = cont9u+ pr(essional 
education cr$it reg>d+ vet]an cultural  
compet5cy & o!r subjects z det]m9$      
appropriate by ! ,secret>y & to bett]   
acc\nt = equival5t or simil>            

non-,dep>tm5t tra9+2  7,c7 to improve ! 
rate ( ! timely return to ! ,dep>tm5t ( 
m$ical record docum5tation = c>e or     
s]vices provid$ "u su* program2  7,d7 to
 improve ! timel9ess & quality ( !      
deliv]y ( c>e & s]vices to vet]ans "u   
su* program2 &  7,e7 to a*ieve su* o!r  
objectives z det]m9$ appropriate by !   
,secret>y 9 consultation ) ,?ird ,p>ty  
,adm9i/rators2  7#b7 to decrease ! rate 
( no-%[ appo9tm5ts "u su* program &     
consid] ! feasibility & advisability (  
appropriately comp5sat+ su* heal? c>e   
provid]s = no-%[ appo9tm5ts "u su*      
program2 &  7#c7 )9 ea* region 9 :i* su*
 program is c>ri$ out1 to assess ne$$   
specialties & inc5tivize community      
provid]s 9 ^? specialties to p>ticipate 
9 su* program4  7b7 ,value-,bas$        
reimbursem5t models ,9 develop+ ! plan  
"u subsection 7a71 ! ,secret>y & ,?ird  
,p>ty ,adm9i/rators %all explore        
value-bas$ reimbursem5t models au?oriz$ 
to be us$ "u section #agjc7;i77#e7 (    
title #ch1 ,unit$ ,/ates ,code1 to      

a*ieve ! goals "u su* subsection4  7c7  
,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 dur+ !      
five-ye> p]iod foll[+ ! submittal ( !   
plan "u p>agraph 7#a71 ! ,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  
7#c7 ,use ( value-bas$ reimbursem5t     
models ,! ,secret>y %all include ) !    
plan submitt$ "u p>agraph 7#a7 & any    
report submitt$ "u p>agraph 7#b7-- 7,a7 
a complete li/ ( ! value-bas$           
reimbursem5t models consid]$ "u ! plan2 
7,b7 an indication ( :e!r any su* model 
has be5 put into practice2 &  7,c7 )    

respect to any su* model t 0 consid]$ b 
n put into practice1 a description ( !  
reasons su* model 0 n put into practice4
  7d7 ,no p5alty = n meet+ objectives   
,heal? c>e provid]s specifi$ 9 section  
#agjc7;c7 ( title #ch1 ,unit$ ,/ates    
,code1 %all n be p5aliz$ = n meet+ an   
objective "u p>agraph 7#a7 ( subsection 
7a7 includ$ 9 ! plan requir$ "u su*     
subsection4  7e7 ,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  7f7 ,?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  #aji4 ,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  #aaj4 
,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  #aaa4 ,inspector ,g5]al assessm5t 
( implem5tation ( ,vet]ans ,community   
,c>e ,program  7a7 ,9 g5]al ,n lat] ?an 
?ree ye>s aft] ! date ( ! enactm5t ( ?is
 ,act1 & p]iodically !reaft] z !        
,inspector ,g5]al ( ! ,dep>tm5t (       
,vet]ans ,affairs consid]s appropriate1 
! ,inspector ,g5]al %all assess !       
p]=mance ( ea* m$ical c5t] ( ! ,dep>tm5t
 ( ,vet]ans ,affairs 9-- 7#a7           
appropriately id5tify+ vet]ans eligible 
= c>e & s]vices "u section #agjc ( title
 #ch1 ,unit$ ,/ates ,code2  7#b7 in=m+  
vet]ans ( _! eligibility = su* c>e &    
s]vices1 includ+1 if appropriate &      
applicable1 ! availability ( su* c>e &  
s]vices via teleheal?2  7#c7 deliv]+ su*
 c>e & s]vices 9 a timely mann]2 &  7#d7
 appropriately coord9at+ su* c>e &      
s]vices4  7b7 ,comm5cem5t ( assessm5t ,n
 lat] ?an "o ye> aft] ! date ( !        
enactm5t ( ?is ,act1 ! ,inspector ,g5]al
 ( ! ,dep>tm5t %all comm5ce ! initial   
assessm5t requir$ by subsection 7a74    

,,ii ,o!r heal? c>e matt]s  #bja4       
,/rategic plan on transition ( ,vet]ans 
,heal? ,adm9i/ration to value-bas$ heal?
 c>e model  7a7 ,f9d+s ,congress makes !
 foll[+ f9d+s3 7#a7 ,! f9al report ( !  
,creat+ ,options = ,vet]ans' ,exp$it$   
,recov]y ,commission 7commonly ref]r$ to
 z ! ,,cov] ,commission7 e/abli%$ "u    
section #ica ( ! ,jason ,simcakoski     
,memorial & ,promise ,act 7title ,,ix ( 
,public ,law #aad-aih2 #ch ,u4,s4,c4    
#agja note7 submitt$ "u subsection      
7e77#b7 ( su* section made a key        
recomm5dation to trans=m ! curr5t heal? 
c>e deliv]y model ( ! ,dep>tm5t (       
,vet]ans ,affairs into "o t is          
p]son-c5t]$1 relation%ip-bas$1 &        
recov]y-focus$1 & to support t          
trans=mation ) a sy/em t is value-bas$ &
 inc5tiviz$ = cont9u\s innovation &     
quality improvem5t4  7#b7 ,! cons5sus   
/udy report ( ! ,heal? & ,m$ic9e        
,division ( ! ,national ,academies (    
,sci5ces1 ,eng9e]+1 & ,m$ic9e dat$      
,febru>y #bjbb & entitl$1 ,a*iev+ ,:ole 

,heal?3 ,a ,new ,approa* = ,vet]ans & ! 
,nation recomm5ds ! ,vet]ans ,heal?     
,adm9i/ration adopt a value-bas$ model  
to align ) deliv]+ :ole heal? c>e4  7#c7
 ,! cons5sus /udy report ( ! ,national  
,academy ( ,m$ic9e dat$ ,octob] #bjbj   
f\nd t a value-bas$ c>e model helps     
r$uce physician burn\t4  7#d7 ,!        
,national ,academy ( ,m$ic9e has        
develop$ a widely accept$ approa* t     
describes high-value heal? c>e z safe1  
timely1 effective1 effici5t1 equitable1 
& pati5t-c5t]$ 7,,/eeep74 ,fur!r1 !     
,in/itute = ,heal?c>e ,improvem5t has   
translat$ t approa* into a framework =  
action kn[n z ! ,quadruple ,aim4 ,!     
,quadruple ,aim is made up ( bett]      
pati5t outcomes1 improv$ pati5t         
satisfaction1 l[] co/s1 & physician &   
heal? c>e pr(essional well-be+4  7#e7   
,heal? c>e sy/ems t h made ! transition 
to value-bas$ c>e h se5 a significant   
decrease 9 suicides among _! pati5t     
population1 & ! top cl9ical priority ( !
 ,vet]ans ,heal? ,adm9i/ration is       

suicide prev5tion4  7#f7 ,value-bas$ c>e
 programs c enc\rage provid]s to "w     
toge!r to deliv] coord9at$1 p]son-c5t]$ 
c>e1 :i* w improve ! ov]all quality (   
c>e4  7#g7 ,a critical compon5t ( a     
successful transition to a value-bas$   
c>e deliv]y model is an op]ational      
electronic heal? record sy/em 9 place z 
a f\ndation4  7b7 ,e/abli%m5t ( work+   
gr\p  7#a7 ,9 g5]al ,n lat] ?an #ij days
 aft] ! date ( ! enactm5t ( ?is ,act1 ! 
,secret>y ( ,vet]ans ,affairs %all      
e/abli% a work+ gr\p on ! %ift ( !      
,vet]ans ,heal? ,adm9i/ration to a      
value-bas$ c>e sy/em4  7#b7 ,memb]%ip   
7,a7 ,requir$ memb]s ,! work+ gr\p %all 
include1 at a m9imum1 ! foll[+ memb]s3  
7i7 ,! ,"u ,secret>y ( ,vet]ans ,affairs
 = ,heal?4  7ii7 ,! ,director ( ! ,(fice
 ( ,m5tal ,heal? & ,suicide ,prev5tion (
 ! ,dep>tm5t ( ,vet]ans ,affairs1 or    
successor (fice4  7iii7 ,! ,director ( !
 ,(fice ( ,integrat$ ,vet]an ,c>e ( !   
,dep>tm5t1 or successor (fice4  7iv7 ,! 
,director ( ! ,(fice ( ,rural ,heal? ( !

 ,dep>tm5t1 or successor (fice4  7v7 ,! 
,director ( ! ,(fice ( ,connect$ ,c>e ( 
! ,dep>tm5t1 or successor (fice4  7vi7  
,! ,director ( ! ,(fice ( ,in=mation &  
,te*nology ( ! ,dep>tm5t1 or successor  
(fice4  7vii7 ,! ,*ief ,(fic] ( ! ,(fice
 ( ,heal?c>e ,innovation & ,le>n+ ( !   
,(fice ( ,discov]y1 ,education1 &       
,affiliate ,networks ( ! ,vet]ans ,heal?
 ,adm9i/ration1 or successor (fice4     
7viii7 ,an individual designat$ by !    
,secret>y f ! ,c5t] = ,innovation = ,c>e
 & ,paym5t ( ! ,dep>tm5t "u section     
#agjc;,e ( title #ch1 ,unit$ ,/ates     
,code4  7ix7 ,an individual designat$ by
 ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e    
,m$icaid ,s]vices f ! ,c5t] = ,m$ic>e & 
,m$icaid ,innovation4  7x7 ,an          
individual designat$ by ! ,secret>y (   
,heal? & ,human ,s]vices f ! ,f$]al     
,(fice ( ,rural ,heal? ,policy ( !      
,heal? ,res\rces & ,s]vices             
,adm9i/ration4  7,b7 ,optional memb]s ,!
 ,secret>y ( ,vet]ans ,affairs may      
appo9t any ( ! foll[+ individuals z     

memb]s ( ! work+ gr\p3 7i7 ,an          
individual repres5t+ ! ,heal? & ,m$ic9e 
,division ( ! ,national ,academies (    
,sci5ces1 ,eng9e]+1 & ,m$ic9e4  7ii7 ,an
 individual designat$ by ! ,*airman ( ! 
,vet]ans' ,exp$it$ ,recov]y ,commission 
7commonly ref]r$ to z ! ,,cov]          
,commission7 e/abli%$ "u section #ica ( 
! ,jason ,simcakoski ,memorial &        
,promise ,act 7title ,,ix ( ,public ,law
 #aad-aih2 #ch ,u4,s4,c4 #agja note74   
7iii7 ,?ree individuals repres5t+ a     
private heal? c>e sy/em t has made !    
transition to value-bas$ c>e4  7iv7     
,?ree individuals repres5t+ a heal? c>e 
provid] p>ticipat+ 9 ! ,vet]ans         
,community ,c>e ,program "u section     
#agjc ( title #ch1 ,unit$ ,/ates ,code1 
t op]ates "u a value-bas$ c>e model4    
7v7 ,an individual repres5t+ an         
organization recogniz$ by ! ,secret>y ( 
,vet]ans ,affairs "u section #eijb (    
title #ch1 ,unit$ ,/ates ,code4  7#c7   
,exemption f application ( ,,faca ,*apt]
 #aj ( title #e1 ,unit$ ,/ates ,code1   

%all n apply to ! work+ gr\p e/abli%$ "u
 p>agraph 7#a74  7c7 ,developm5t (      
/rategic plan  7#a7 ,9 g5]al ,n lat] ?an
 "o ye> aft] ! e/abli%m5t ( ! work+ gr\p
 "u subsection 7b71 ! work+ gr\p %all   
develop a /rategic plan to %ift !       
,vet]ans ,heal? ,adm9i/ration to a      
value-bas$ c>e sy/em4  7#b7 ,elem5ts ,! 
/rategic plan requir$ "u p>agraph 7#a7  
%all conta9 ! foll[+ elem5ts3 7,a7 ,an  
id5tification ( ! curr5t /ate ( !       
,vet]ans ,heal? ,adm9i/ration1 includ+  
an assessm5t ( ! curr5t model ( heal?   
c>e deliv]y us$ by ! ,vet]ans ,heal?    
,adm9i/ration 9 m$ical facilities ( !   
,dep>tm5t ( ,vet]ans ,affairs & ?r\gh ! 
,vet]ans ,community ,c>e ,program "u    
section #agjc ( title #ch1 ,unit$ ,/ates
 ,code1 9 comp>ison to a value-bas$ c>e 
sy/em4  7,b7 ,an analysis ( ! lead]%ip (
 ! ,vet]ans ,heal? ,adm9i/ration1       
includ+ an assessm5t ( lead]%ip acum5 & 
ability to implem5t a %ift ) a cle>1 %>$
 vision & effective *ange managem5t &   
c>e coord9ation4  7,c7 ,an id5tification

 ( goals = ! future ( ! ,vet]ans ,heal? 
,adm9i/ration4  7,d7 ,an id5tification &
 classification ( ! curr5t capabilities 
& gaps ( ! heal? c>e sy/em ( ! ,dep>tm5t
 ( ,vet]ans ,affairs4  7,e7 ,an analysis
 ( ! f\r ma9 types ( value-bas$ c>e     
models1 includ+-- 7i7 a selection ( !   
model t be/ fits a successful transition
 = ! ,vet]ans ,heal? ,adm9i/ration2 &   
7ii7 a ?or\gh ju/ification ( ! selection
 ( su* model4  7,f7 ,a def9ition ( :at  
quality means ) respect to access to    
heal? c>e & deliv]y ( heal? c>e4  7,g7  
,a def9ition ( :at value means ) respect
 to c>e furni%$ by ! ,vet]ans ,heal?    
,adm9i/ration1 a sy/em1 ) metrics1 =    
measur+ value )9 ! ,vet]ans ,heal?      
,adm9i/ration t includes outcomes1      
safety1 s]vice1 access1 & total co/ (   
pati5t c>e1 & an analysis ( v>iable     
value ) respect to pati5t outcomes      
across diff]5t heal? c>e types &        
specialities4  7,h7 ,an assessm5t ( !   
curr5t in=mation te*nology infra/ructure
 ( ! ,vet]ans ,heal? ,adm9i/ration & any

 recomm5dations to make su*             
infra/ructure m robu/4  7,i7 ,an        
assessm5t ( ! work=ce *all5ges & ne$s ( 
! ,vet]ans ,heal? ,adm9i/ration1 includ+
 ) respect to recruitm5t & ret5tion & ! 
effectiv5ess ( ! ability ( ! p]=mance   
appraisal sy/em ( ! ,vet]ans ,heal?     
,adm9i/ration to appropriately          
inc5tivize & rew>d employees & ensure   
adh]5ce to relevant /atutes1            
regulations1 policy directives1 &       
treatm5t guidel9es4  7,j7 ,an assessm5t 
( ! curr5t value-driv5 framework ( !    
,dep>tm5t = evaluat+ heal? c>e          
innovations & h[ t framework c\ld be us$
 to propel a %ift 9 ! model ( c>e       
deliv]y by ! ,dep>tm5t4  7,k7 ,a focus  
on value-bas$ c>e = prim>y c>e1 inpati5t
 & outpati5t m5tal heal? c>e1 & inpati5t
 & outpati5t sub/ance use treatm5t4     
7,l7 ,a description ( ! timel9e1 co/s1 &
 legislative or adm9i/rative action     
necess>y to transition ! ,vet]ans ,heal?
 ,adm9i/ration to a value-bas$ c>e      
sy/em4  7d7 ,submittal ( /rategic plan  

to ,congress ,n lat] ?an #cj days aft] !
 completion by ! work+ gr\p e/abli%$ "u 
subsection 7b7 ( ! /rategic plan requir$
 "u subsection 7c71 ! ,secret>y (       
,vet]ans ,affairs %all submit ! /rategic
 plan to ! ,committee on ,vet]ans'      
,affairs ( ! ,s5ate & ! ,committee on   
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives4  7e7 ,pilot program    
implem5tation ( /rategic plan  7#a7 ,9  
g5]al ,n lat] ?an #ahj days aft] !      
submittal "u subsection 7d7 ( ! /rategic
 plan requir$ "u subsection 7c71 !      
,secret>y ( ,vet]ans ,affairs %all      
comm5ce a five-ye> pilot program to     
implem5t ! /rategic plan4  7#b7 ,c>e    
includ$ ,! pilot program "u p>agraph    
7#a7 %all include ! implem5tation ( !   
/rategic plan = ! deliv]y by ! ,vet]ans 
,heal? ,adm9i/ration ( prim>y c>e1      
inpati5t & outpati5t m5tal heal?        
treatm5t1 & inpati5t & outpati5t        
sub/ance use treatm5t4  7#c7 ,locations 
,! ,secret>y %all c>ry out ! pilot      
program "u p>agraph 7#a7 9 f\r ,vet]ans 

,integrat$ ,s]vice ,networks t are      
geographically disp]s$ & %all include ! 
foll[+3 7,a7 ,a ,vet]ans ,integrat$     
,s]vice ,network t pr$om9ately s]ves    
vet]ans 9 rural & highly rural areas4   
7,b7 ,a ,vet]ans ,integrat$ ,s]vice     
,network t pr$om9ately s]ves vet]ans 9  
urban areas4  7,c7 ,a ,vet]ans          
,integrat$ ,s]vice ,network t has a high
 rate ( suicide among vet]ans4  7,d7 ,a 
,vet]ans ,integrat$ ,s]vice ,network t  
has a high rate ( sub/ance use disord]  
among vet]ans4  7,e7 ,a ,vet]ans        
,integrat$ ,s]vice ,network ) a docum5t$
 issue ) work=ce recruitm5t & ret5tion4 
7#d7 ,reports to ,congress  7,a7 ,annual
 report ,n lat] ?an "o ye> aft] !       
comm5cem5t ( ! pilot program1 & annually
 !reaft] dur+ ! duration ( ! pilot      
program1 ! ,secret>y %all submit to     
,congress a report on ! pilot program4  
7,b7 ,f9al report ,n lat] ?an #ahj days 
be=e ! conclusion ( ! pilot program1 !  
,secret>y %all submit to ,congress a    
f9al report on ! pilot program t        

includes a plan & timel9e = full        
implem5tation ( ! /rategic plan requir$ 
"u subsection 7c7 across ! entire       
,vet]ans ,heal? ,adm9i/ration4  #bjb4   
,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
  #bjc4 ,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$ical c5t]s4  4 
#bjd4 ,docum5tation ( pref]5ces (       
vet]ans = s*$ul+ ( appo9tm5ts = c>e  7a7
 ,9 g5]al ,^u enrollm5t ( a vet]an 9 !  
sy/em ( annual pati5t enrollm5t ( !     
,dep>tm5t ( ,vet]ans ,affairs e/abli%$ &
 op]at$ "u section #agje7;a7 ( title    
#ch1 ,unit$ ,/ates ,code1 & n less      
frequ5tly ?an annually !reaft]1 !       
,secret>y ( ,vet]ans ,affairs %all      
solicit f ! vet]an ! pref]5ce ( ! vet]an
 = s*$ul+ ( appo9tm5ts = heal? c>e &    
relat$ s]vices furni%$ by ! ,dep>tm5t1  
includ+ ?r\gh non-,dep>tm5t provid]s4   
7b7 ,docum5tation ( pref]5ce ,pref]5ces 
provid$ by a vet]an pursuant to         
subsection 7a7 %all be docum5t$ on ,my  
,healthe,vet or ano!r sy/em designat$ by
 ! ,secret>y t all[s ! vet]an to *ange  
su* pref]5ces at any "t4  7c7 ,inclusion
 9 pref]5ce ,pref]5ces solicit$ "u      
subsection 7a7 %all include ! foll[+3   

7#a7 ,h[ & :5 ! vet]an pref]s to be     
contact$ by ! ,dep>tm5t ab\t an         
appo9tm5t = heal? c>e4  7#b7 ,:e!r !    
vet]an pref]s to s*$ule _! own          
appo9tm5ts1 if able4  7#c7 ,:e!r !      
vet]an pref]s to select _! own provid]1 
if able4  7#d7 ,:e!r ! vet]an pref]s    
appo9tm5ts to be s*$ul$ dur+ c]ta9 days 
or times4  7#e7 ,:e!r ! vet]an is will+ 
to consid] teleheal? appo9tm5ts4  7d7   
,use ( pref]5ce ,! ,secret>y %all make !
 pref]5ces provid$ "u subsection 7a7    
easily accessible to m$ical support     
assi/ants & o!r /aff ( ! ,dep>tm5t      
assi/+ 9 ! appo9tm5t s*$ul+ process to  
use to improve ! timel9ess ( ! s*$ul+ ( 
appo9tm5ts = heal? c>e & relat$ s]vices 
furni%$ by ! ,dep>tm5t1 includ+ ?r\gh   
non-,dep>tm5t provid]s4  #bje4 ,/aff+   
model & p]=mance metrics = c]ta9        
employees ( ! ,dep>tm5t ( ,vet]ans      
,affairs  7a7 ,/aff+ model  7#a7 ,9     
g5]al ,n lat] ?an "o ye> aft] ! date ( !
 enactm5t ( ?is ,act1 ! ,secret>y (     
,vet]ans ,affairs %all-- 7,a7 develop1  

validate1 & implem5t a /aff+ model = !  
,(fice ( ,integrat$ ,vet]an ,c>e ( !    
,dep>tm5t ( ,vet]ans ,affairs1 or       
successor (fice1 ,vet]ans ,integrat$    
,s]vices ,networks1 & m$ical c5t]s ( !  
,dep>tm5t t includes appropriate t>get  
/aff+ levels nationally1 regionally1 &  
locally to ensure timely access to c>e &
 effectively ov]see ! provision ( c>e by
 ! ,dep>tm5t1 :e!r at a facility ( !    
,dep>tm5t or ?r\gh a non-,dep>tm5t      
provid]2 &  7,b7 provide to ,congress a 
brief+ on su* /aff+ model1 :i* %all     
include-- 7i7 ! metrics & measures us$  
by ! ,secret>y 9 develop+ su* /aff+     
model2 &  7ii7 an analysis ( h[ su*     
/aff+ model comp>es to ! /aff+ models ( 
o!r relevant gov]nm5t & private sector  
heal? c>e sy/ems4  7#b7 ,report on      
implem5tation ( /aff+ model ,n lat] ?an 
"o ye> aft] implem5t+ ! /aff+ model     
requir$ "u p>agraph 7#a71 ! ,secret>y   
%all submit to ,congress & ! ,comptroll]
 ,g5]al ( ! ,unit$ ,/ates a report      
conta9+-- 7,a7 an update on su*         

implem5tation2 &  7,b7 in=mation on !   
outcomes yield$ by su* /aff+ model 9    
t]ms ( improv$ access to c>e = vet]ans &
 improv$ compliance ) relevant laws1    
regulations1 policy directives1 &       
guidance gov]n+ access to c>e4  7b7     
,p]=mance metrics  7#a7 ,9 g5]al ,n lat]
 ?an "o ye> aft] ! date ( ! enactm5t (  
?is ,act1 ! ,secret>y %all develop &    
implem5t a plan to incorporate          
appropriate p]=mance metrics &          
acc\ntability measures )9 ! p]=mance    
appraisal sy/ems = employees ( !        
,dep>tm5t specifi$ 9 p>agraph 7#b74     
7#b7 ,employees ( ! ,dep>tm5t specifi$  
,employees ( ! ,dep>tm5t specifi$ 9 ?is 
p>agraph are employees :o are           
responsible = ensur+ timely access to   
c>e f ! ,dep>tm5t1 compliance ) relevant
 /atutes & regulations relat+ to !      
provision ( c>e1 includ+ section #agjc (
 title #ch1 ,unit$ ,/ates ,code1 &      
ov]see+ ! provision ( c>e1 :e!r at a    
facility ( ! ,dep>tm5t or ?r\gh a       
non-,dep>tm5t provid]1 includ+ employees

 )9 ! ,(fice ( ,integrat$ ,vet]an ,c>e (
 ! ,dep>tm5t1 or successor (fice1       
employees ( a ,vet]ans ,integrat$       
,s]vice ,network1 & employees ( a m$ical
 c5t] ( ! ,dep>tm5t4  7#c7 ,report on   
implem5tation ( p]=mance metrics ,n lat]
 ?an "o ye> aft] implem5t+ ! p]=mance   
metrics requir$ "u p>agraph 7#a71 !     
,secret>y %all submit to ,congress & !  
,comptroll] ,g5]al ( ! ,unit$ ,/ates a  
report conta9+-- 7,a7 an update on su*  
implem5tation2 &  7,b7 in=mation on !   
outcomes yield$ by su* p]=mance metrics 
9 t]ms ( improv$ access to c>e = vet]ans
 & improv$ compliance ) relevant laws1  
policy directives1 & guidance gov]n+    
access to c>e4  7c7 ,comptroll] ,g5]al  
report ,n lat] ?an two ye>s aft] receiv+
 ! report "u subsection 7a77#b7 or !    
report "u subsection 7b77#c71 :i*ev]    
occurs lat]1 ! ,comptroll] ,g5]al ( !   
,unit$ ,/ates %all submit to ,congress a
 report-- 7#a7 assess+ ! p]=mance ( !   
,(fice ( ,integrat$ ,vet]an ,c>e ( !    
,dep>tm5t1 or successor (fice1 9 improv+

 access to c>e = vet]ans 9 facilities ( 
! ,dep>tm5t & pursuant to section #agjc 
( title #ch1 ,unit$ ,/ates ,code2 &     
7#b7 conta9+ su* recomm5dations z !     
,comptroll] ,g5]al consid]s appropriate 
relat+ to improv+ access to su* c>e4    
#bjf4 ,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  #bjg4
 ,onl9e heal? education portal = vet]ans
 enroll$ 9 pati5t enrollm5t sy/em (     
,dep>tm5t ( ,vet]ans ,affairs ,n lat]   
?an "o ye> aft] ! date ( ! enactm5t (   
?is ,act1 ! ,secret>y ( ,vet]ans        
,affairs %all e/abli% an onl9e heal?    
education portal t includes int]active  
onl9e educational modules to ensure     
vet]ans enroll$ 9 ! pati5t enrollm5t    
sy/em ( ! ,dep>tm5t ( ,vet]ans ,affairs 
e/abli%$ & op]at$ "u section #agje7;a7 (
 title #ch1 ,unit$ ,/ates ,code1 und]/& 
_! basic heal? c>e eligibilities &      
entitlem5ts "u ! laws adm9i/]$ by !     
,secret>y1 includ+ "u ! ,vet]ans        
,community ,c>e ,program "u section     
#agjc ( su* title4  #bjh4 ,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