,,ii #aahth ,,congress #ast ,session ,s4 #bfdi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #bg1 #bjbc ,mr4 ,tester introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,a ,,bill ,to improve community care provided by the ,department of ,veterans ,affairs1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,making ,community ,care ,work for ,veterans ,act of #bjbc4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,improvements to ,community ,care ,sec4 #aja4 ,requirement that appointments for care or services under ,community ,care ,program of ,department of ,veterans ,affairs are timely scheduled4 ,sec4 #ajb4 ,modifications to access standards for care furnished through ,community ,care ,program of ,department of ,veterans ,affairs4 ,sec4 #ajc4 ,consideration of telehealth in determining whether an appointment can be scheduled within the access standards of the ,department of ,veterans ,affairs4 ,sec4 #ajd4 ,finality of decision by veteran and veteran's referring clinician4 ,sec4 #aje4 ,benefits for persons disabled by treatment under ,community ,care ,program of ,department of ,veterans ,affairs4 ,sec4 #ajf4 ,extension of period for submittal of claims by health care entities and providers4 ,sec4 #ajg4 ,program on self-referral of veterans for certain services under ,veterans ,community ,care ,program4 ,sec4 #ajh4 ,report on referrals for non-,department of ,veterans ,affairs health care4 ,sec4 #aji4 ,requirement that health care providers under ,community ,care ,program of ,department of ,veterans ,affairs provide certain data4 ,sec4 #aaj4 ,high-compliance rating program for providers under ,veterans ,community ,care ,program of ,department of ,veterans ,affairs4 ,sec4 #aaa4 ,adoption of national interoperability standards between ,department of ,veterans ,affairs and community care providers4 ,sec4 #aab4 ,analysis of feasibility and advisability of establishing a community care network for the provision of care to veterans in the ,republic of the ,philippines4 ,sec4 #aac4 ,pilot program on consolidating the community care dental treatment plan approval process of ,department of ,veterans ,affairs4 ,sec4 #aad4 ,reviews of payment rate waivers under ,veterans ,community ,care ,program4 ,sec4 #aae4 ,comptroller ,general report on dentistry under ,veterans ,community ,care ,program4 ,,title ,,ii--,health care employees ,sec4 #bja4 ,establishment of ,start and ,stay at ,,va program4 ,sec4 #bjb4 ,expansion of period of payment under ,employee ,incentive ,scholarship ,program4 ,sec4 #bjc4 ,mentorship program for executive leadership teams at medical centers of the ,department of ,veterans ,affairs4 ,,title ,,iii--,other health care matters ,sec4 #cja4 ,timing for scheduling of appointments at facilities of ,department of ,veterans ,affairs4 ,sec4 #cjb4 ,modification of requirements for standards for quality of care from ,department of ,veterans ,affairs4 ,sec4 #cjc4 ,mental ,health ,residential ,rehabilitation ,treatment ,program of the ,department of ,veterans ,affairs4 ,sec4 #cjd4 ,electronic document submission option for the ,,champva program4 ,sec4 #cje4 ,review of workflows associated with processing referrals between facilities of the ,veterans ,health ,administration4 ,i ,improvements to ,community ,care #aja4 ,requirement that appointments for care or services under ,community ,care ,program of ,department of ,veterans ,affairs are timely scheduled 7a7 ,in general ,section #agjc of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by redesignating subsections 7m71 7n71 and 7o7 as subsections 7n71 7o71 and 7p71 respectively2 and 7#b7 by inserting after subsection 7l7 the following new subsection 7m73 7m7 ,scheduling of appointments 7#a7 ,the ,secretary shall ensure that an appointment for a covered veteran for care or services under this section-- 7,a7 in the case of a non-urgent appointment1 is scheduled 7but may occur at a later date7 not later than seven days after the earlier of the date on which-- 7i7 a clinician of the ,department determines that the veteran requires care2 or 7ii7 the veteran presents to the ,department requesting care2 and 7,b7 in the case of an appointment for urgent care1 is completed not later than #dh hours after the earlier of the date on which-- 7i7 a clinician of the ,department determines that the veteran requires care2 or 7ii7 the veteran presents to the ,department requesting care4 7#b7 ,not less frequently than quarterly1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the average time it takes each medical facility of the ,department to schedule appointments for care or services under this section1 broken out by primary care1 mental health care1 and each type of specialty care4 7#c7 7,a7 ,each medical facility of the ,department for which any average time reported under paragraph 7#b7 is more than seven days shall submit to the ,under ,secretary for ,health1 not later than #cj days after the date of the report-- 7i7 an explanation for why such average time is more than seven days1 which may include staffing shortages1 insufficient network1 surge of appointments1 and any other factor increasing such average time2 7ii7 a remediation plan to bring such average time to not more than seven days2 and 7iii7 an explanation for how each issue specified in clause 7i7 is being mitigated4 7,b7 ,with respect to any explanation under subparagraph 7,a77i7 that specifies insufficient network1 the ,under ,secretary for ,health shall-- 7i7 consult with any third party administrator responsible for administering such network on how network insufficiency can be overcome2 and 7ii7 examine whether the third party administrator is meeting contractual obligations4 4 7b7 ,effective date ,the ,secretary of ,veterans ,affairs shall comply with the requirements under section #agjc7m77#a7 of title #ch1 ,united ,states ,code1 as added by subsection 7a77#b71 by not later than #ahj days after the date of the enactment of this ,act4 #ajb4 ,modifications to access standards for care furnished through ,community ,care ,program of ,department of ,veterans ,affairs 7a7 ,in general ,section #agjc;,b of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by striking subsections 7a7 through 7d7 and inserting the following3 7a7 ,threshold eligibility standards for access to community care ,a covered veteran shall be eligible to elect to receive1 pursuant to subsection 7d77#c7 of section #agjc of this title1 non-,department hospital care1 medical services1 or extended care services under such section pursuant to subsection 7d77#a77;,d7 of such section using the following eligibility standards for access to community care3 7#a7 ,with respect to primary care1 mental health care1 or non-institutional extended care services1 if the ,secretary cannot schedule an appointment for the covered veteran with a health care provider of the ,department-- 7,a7 not more than #cj minutes average driving time from the residence of the veteran2 and 7,b7 not later than #bj days from the date of request for such an appointment1 unless a later date has been agreed to by the veteran in consultation with the health care provider1 to the first next available appointment date relevant to the requested medical service4 7#b7 ,with respect to specialty care or specialty services1 if the ,secretary cannot schedule an appointment for the covered veteran with a health care provider of the ,department-- 7,a7 not more than #fj minutes average driving time from the residence of the veteran2 and 7,b7 not later than #bh days from the date of request for such an appointment1 unless a later date has been agreed to by the veteran in consultation with the health care provider1 to the first next available appointment date relevant to the requested medical service4 2 7#b7 by redesignating subsections 7e71 7f71 7g71 7h71 and 7i7 as subsections 7b71 7c71 7d71 7e71 and 7f71 respectively2 7#c7 in subsection 7b71 as redesignated by paragraph 7#b7-- 7,a7 in the matter preceding paragraph 7#a71 by striking ,not later than #c years after the date on which the ,secretary establishes access standards under subsection 7a7 and not less frequently than once every #c years thereafter and inserting ,review and report4--,not less frequently than once every three years2 7,b7 in paragraph 7#a71 by striking such standards and inserting the eligibility standards for access to community care under subsection 7a72 and 7,c7 in paragraph 7#b71 by striking and any modification to the access standards with respect to the review conducted under paragraph 7#a7 and inserting of such review and such recommendations as the ,secretary may have with respect to such eligibility standards2 7#d7 in subsection 7c71 as so redesignated-- 7,a7 in paragraph 7#a7-- 7i7 by striking 7#a7 ,subject to paragraph 7#c7 and inserting ,requirement ,to meet standards4--7#a7 ,subject to paragraphs 7#c7 and 7#d72 and 7ii7 by inserting and health care providers specified under section #agjc7;c7 of this title before the period at the end2 7,b7 in paragraph 7#b71 by striking ,the ,secretary and inserting ,subject to paragraphs 7#c7 and 7#d71 the ,secretary2 and 7,c7 by adding at the end the following new paragraph3 7#d7 7,a7 ,a health care provider specified under section #agjc7;c7 of this title that is furnishing care pursuant to a contract1 agreement1 or other arrangement between such provider and the ,secretary may request a waiver to the requirement under this subsection to meet the access standards established under subsection 7a74 7,b7 ,any waiver requested by a health care provider under subparagraph 7,a7 must be requested in writing and submitted to the ,secretary for approval4 7,c7 ,in evaluating a waiver request by a health care provider under subparagraph 7,a71 the ,secretary shall consider the factors specified under paragraph 7#c77;,d7 that are relevant to the health care provider4 2 7#e7 in subsection 7d77#a71 as so redesignated1 by striking 7#a7 ,the ,secretary and inserting ,publication4--7#a7 ,the ,secretary2 7#f7 in subsection 7e77#a71 as so redesignated1 by striking 7#a7 ,consistent with and inserting ,determination regarding eligibility4--7#a7 ,consistent with2 and 7#g7 in subsection 7f71 as so redesignated1 by striking ,in this section and inserting ,definitions4--,in this section4 7b7 ,conforming amendments ,section #agjc7;d7 of such title is amended-- 7#a7 in paragraph 7#a77;,d71 by striking developed by the ,secretary2 and 7#b7 in paragraph 7#c71 by striking developed by the ,secretary4 #ajc4 ,consideration of telehealth in determining whether an appointment can be scheduled within the access standards of the ,department of ,veterans ,affairs ,section #agjc7;d7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#d7 ,in determining under paragraph 7#a77;,d7 whether the ,department is able to furnish care or services in a manner that complies with the access standards established under section #agjc;,b7a7 of this title1 for purposes of determining the availability of an appointment1 a telehealth appointment will only be considered as an available appointment if the veteran accepts the use of telehealth by the ,department4 4 #ajd4 ,finality of decision by veteran and veteran's referring clinician ,section #agjc7;d7 of title #ch1 ,united ,states ,code1 as amended by section #ajc1 is further amended by adding at the end the following new paragraph3 7#e7 7,a7 ,subject to subparagraph 7,b71 an agreement by a covered veteran and the covered veteran's referring clinician under paragraph 7#a77;,e7 regarding the best medical interest of the covered veteran is final and is not subject to review or approval by the ,department4 7,b7 ,a covered veteran and the covered veteran's referring clinician may correct any errors made with respect to an agreement described in subparagraph 7,a74 4 #aje4 ,benefits for persons disabled by treatment under ,community ,care ,program of ,department of ,veterans ,affairs 7a7 ,in general ,subsection 7a7 of section #aaea of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by redesignating paragraph 7#b7 as paragraph 7#c72 7#b7 in paragraph 7#a77;,b71 by striking or at the end2 and 7#c7 by inserting after paragraph 7#a7 the following new paragraph 7#b73 7#b7 the disability or death was caused by hospital care1 a medical service1 or an extended care service furnished the veteran by a non-,department provider under section #agjc of this title and the proximate cause of the disability or death was-- 7,a7 carelessness1 negligence1 lack of proper skill1 error in judgment1 or similar instance of fault on the part of the provider in furnishing the hospital care1 medical service1 or extended care service2 or 7,b7 an event not reasonably foreseeable2 or 4 7b7 ,offset of awards ,such section is amended by adding at the end the following new subsection3 7d7 ,the amount of any judgment awarded to an individual in a civil action brought by the individual against a non-,department provider in a court of competent jurisdiction for a disability or death caused by hospital care1 a medical service1 or an extended care service furnished by a non-,department provider as described in subsection 7a77#b7 shall be offset by the amount of any compensation awarded to the individual under such subsection for such disability or death4 4 #ajf4 ,extension of period for submittal of claims by health care entities and providers ,section #agjc;,d7b7 of title #ch1 ,united ,states ,code1 is amended by striking #ahj days and inserting one year4 #ajg4 ,program on self-referral of veterans for certain services under ,veterans ,community ,care ,program 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall carry out a program 7in this section referred to as the ,program7 under which the ,secretary may furnish outpatient services specified in subsection 7b7 through a health care provider specified in section #agjc7;c7 of title #ch1 ,united ,states ,code1 to a covered veteran who-- 7#a7 is eligible for such services under criteria to be established by the ,secretary2 and 7#b7 chooses to self-refer for such services4 7b7 ,outpatient services specified ,the outpatient services specified in this subsection are the following3 7#a7 ,vaccinations4 7#b7 ,vision and hearing services4 7c7 ,conditions under which services are provided ,the ,secretary shall provide services under the ,program under the same conditions as such services would be required to be provided under section #agjc7;d7 of title #ch1 ,united ,states ,code4 7d7 ,report on program 7#a7 ,in general ,not later than two years after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary shall submit to ,congress a report on the ,program4 7#b7 ,elements ,each report required under paragraph 7#a7 shall include1 for the one-year period preceding the date of the report-- 7,a7 the number of self-referrals made under the ,program1 disaggregated by type of services sought2 7,b7 an assessment of the timeliness of appointments made under the ,program as compared with the timeliness of other appointments made for the same service2 7,c7 an assessment of satisfaction of veterans with the ,program2 7,d7 an assessment of the impact of the ,program on the health of patients receiving services under the ,program2 and 7,e7 such recommendations as the ,secretary may have for services to be added or removed from the ,program4 7e7 ,effective date ,this section shall take effect on the date that is one year after the date of the enactment of this ,act4 7f7 ,covered veteran defined ,in this section1 the term covered veteran means a veteran described in section #agjc7;b7 of title #ch1 ,united ,states ,code4 #ajh4 ,report on referrals for non-,department of ,veterans ,affairs health care ,not later than #ahj days after the date of the enactment of this ,act1 and not less frequently than monthly thereafter1 the ,secretary of ,veterans ,affairs shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report containing1 with respect to referrals for non-,department of ,veterans ,affairs health care originating from medical facilities of the ,department during the one-month period preceding the date of the report1 a measurement of1 for each such facility of the ,department-- 7#a7 the period of time between-- 7,a7 the date that a clinician of the ,department determines that a veteran requires care1 or a veteran presents to the ,department requesting care1 and the date that the referral for care is sent to a non-,department health care provider2 7,b7 the date that the referral for care is sent to a non-,department health care provider and the date that a non-,department health care provider accepts the referral2 7,c7 the date that a non-,department health care provider accepts the referral and the date that the referral to a non-,department health care provider is completed2 7,d7 the date that the referral to a non-,department health care provider is completed and the date that an appointment with a non-,department health care provider is made2 and 7,e7 the date that an appointment with a non-,department health care provider is made and the date that an appointment with a non-,department health care provider occurs2 and 7#b7 any other period of time that the ,secretary determines necessary to measure4 #aji4 ,requirement that health care providers under ,community ,care ,program of ,department of ,veterans ,affairs provide certain data 7a7 ,in general ,beginning not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall require that covered providers submit to the ,secretary1 at such time and in such manner as the ,secretary may require1 data required to be collected and considered by the ,secretary under section #agjc;,c7a77#c7 of title #ch1 ,united ,states ,code4 7b7 ,exclusion of covered providers ,the ,secretary may not permit a covered provider to participate in the ,veterans ,community ,care ,program under section #agjc of title #ch1 ,united ,states ,code1 if the provider has not provided to the ,secretary data required under subsection 7a74 7c7 ,other providers ,the ,secretary shall encourage health care providers specified in section #agjc7;c7 of title #ch1 ,united ,states ,code1 that are not covered providers to submit to the ,secretary1 on a voluntary basis1 data described in subsection 7a74 7d7 ,type of data required and waiver 7#a7 ,type of data ,the ,secretary shall determine the data required to be submitted by each type of covered provider under subsection 7a74 7#b7 ,waiver ,the ,secretary may waive the requirement to submit data under subsection 7a7 for a particular type of covered provider if the ,secretary determines that the submittal by that type of provider of such data would-- 7,a7 not be appropriate or relevant2 or 7,b7 constitute too heavy of a burden on the provider4 7e7 ,list of high-,performing providers ,the ,secretary shall publish and maintain on a website of the ,department of ,veterans ,affairs that is available to the public an up-to-date list of all health care providers that-- 7#a7 have provided data described in subsection 7a72 and 7#b7 are high-performing providers1 as determined by the ,secretary4 7f7 ,covered provider defined ,in this section1 the term covered provider means a health care provider specified in section #agjc7;c7 of title #ch1 ,united ,states ,code1 that the ,secretary determines has sufficient resources to submit the data required under subsection 7a7 at the time and in the manner required by the ,secretary under such subsection4 #aaj4 ,high-compliance rating program for providers under ,veterans ,community ,care ,program of ,department of ,veterans ,affairs 7a7 ,program ,the ,secretary of ,veterans ,affairs shall establish a program under which the ,secretary provides a rating of ,high ,compliance for community care providers that comply with the qualifications under subsection 7b74 7b7 ,provider qualifications ,the ,secretary shall provide a community care provider with a rating of ,high ,compliance pursuant to the program established under subsection 7a7 if the provider-- 7#a7 completes certain continuing medical education courses provided by the ,,vha ,,train program or related to the ,opioid ,safety ,initiative1 as determined by the ,secretary2 7#b7 sends to the specific authorizing office or designated ,community ,care ,program office of the ,veterans ,health ,administration the complete medical records and all required treatment documentation1 as identified by the ,secretary1 of not less than #ie percent of the veterans treated by the provider under the ,veterans ,community ,care ,program under section #agjc of title #ch1 ,united ,states ,code1 not later than #ae days after the completion of treatment of such veterans2 and 7#c7 complies with such other criteria as the ,secretary may determine appropriate4 7c7 ,financial incentive ,the ,secretary may provide a financial incentive for community care providers with a ,high ,compliance rating4 7d7 ,program promotion ,the ,secretary shall establish a plan to promote the program established under subsection 7a7 and encourage the participation of community care providers in such program4 7e7 ,publication of list 7#a7 ,initial publication ,the ,secretary shall publish on a publicly available website of the ,veterans ,health ,administration a list of community care providers that earn a ,high ,compliance rating pursuant to the program established under subsection 7a74 7#b7 ,update ,the ,secretary shall update the list required under paragraph 7#a7 not less frequently than weekly4 7f7 ,report ,not later than one year after the establishment of the program under subsection 7a71 and annually thereafter1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the program1 including-- 7#a7 the courses under the ,,vha ,,train program or the ,opioid ,safety ,initiative determined by the ,secretary for purposes of subsection 7b77#a72 and 7#b7 the status of the plans of the ,secretary for promotion under subsection 7c7 of the program established under subsection 7a74 7g7 ,definitions ,in this section3 7#a7 ,community care provider ,the term community care provider means a health care provider specified in subsection 7c7 of section #agjc of title #ch1 ,united ,states ,code1 that is participating in the ,veterans ,community ,care ,program under such section4 7#b7 ,opioid ,safety ,initiative ,the term ,opioid ,safety ,initiative means programs1 processes1 and guidelines of the ,veterans ,health ,administration related to the management of opioid therapy and chronic pain4 7#c7 ,,vha ,,train program ,the term ,,vha ,,train program means the free program of the ,veterans ,health ,administration that offers veteran-specific continuing medical education courses1 or successor similar program4 #aaa4 ,adoption of national interoperability standards between ,department of ,veterans ,affairs and community care providers 7a7 ,in general ,the ,secretary of ,veterans ,affairs1 in consultation with the ,secretary of ,health and ,human ,services1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 and the ,national ,coordinator for ,health ,information ,technology1 shall create and implement a plan for the ,department of ,veterans ,affairs to adopt national interoperability standards for the electronic coordination of care and transfer of health information 7including information relating to dental health7 between the ,department and community care providers for the purposes of health care scheduling1 provisioning1 coordination1 and quality assessment4 7b7 ,exceptions and accommodations for providers with fewer patients ,the plan required to be created and implemented under subsection 7a7 shall include appropriate exceptions and accommodations for community care providers1 especially providers in rural areas and smaller providers1 who see fewer patients under the laws administered by the ,secretary of ,veterans ,affairs and who have not adopted electronic health records to ensure those providers have the option to share health information with the ,department of ,veterans ,affairs via non-electronic methods4 7c7 ,reports 7#a7 ,report on plan ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to ,congress a report on the plan required under subsection 7a71 which shall include-- 7,a7 a gap analysis between current interoperability standards in use between the ,department of ,veterans ,affairs and community care providers and opportunities and advancements in care delivery and coordination and related matters using available current standards and standards under development within the ,federal and non-,federal health care sector1 including an analysis of participation by the ,department and community care providers in the ,trusted ,exchange ,framework and ,common ,agreement2 7,b7 recommendations for further development of interoperability standards2 7,c7 a proposed timeline for adopting interoperability standards under such plan by both the ,department and community care providers2 and 7,d7 an indication of any resources or legislative authorities the ,secretary may request from ,congress to develop and implement adoption of interoperability standards under such plan4 7#b7 ,report on implementation ,not later than #ah months after the date of the enactment of this ,act1 and every #ahj days thereafter until the date that is four years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the implementation and revision of the plan required under subsection 7a71 which shall include-- 7,a7 updates on current gaps in interoperability standards in use between the ,department and community care providers and recommendations for further development of such standards2 and 7,b7 updates on implementation of the plan and adoption of the plan by community care providers and the ,department4 7d7 ,community care provider defined ,in this section1 the term community care provider means a non-,department health care provider providing care 7including dental care7-- 7#a7 under section #agjc of title #ch1 ,united ,states ,code2 7#b7 pursuant to a ,veterans ,care ,agreement under section #agjc;,a of such title2 or 7#c7 under any other law administered by the ,secretary4 #aab4 ,analysis of feasibility and advisability of establishing a community care network for the provision of care to veterans in the ,republic of the ,philippines 7a7 ,in general ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall complete an analysis of the feasibility and advisability of establishing a community care network for the provision of care to veterans in the ,republic of the ,philippines4 7b7 ,report ,not later than #ahj days after the completion of the analysis conducted under subsection 7a71 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report that includes the following3 7#a7 ,the results of such analysis4 7#b7 ,an assessment of the number of veterans residing in the ,republic of the ,philippines who are eligible for the ,foreign ,medical ,program4 7#c7 ,an assessment of the staffing needs and associated costs of establishing a community care network in the ,republic of the ,philippines4 7#d7 ,an assessment of the infrastructure needs and associated costs of establishing a community care network in the ,republic of the ,philippines4 7#e7 ,an assessment of the challenges of establishing a community care network in the ,republic of the ,philippines4 7#f7 ,an assessment of how the ,secretary would determine payment rates for providers participating in a community care network in the ,republic of the ,philippines to account for variances in medical costs in the ,republic of the ,philippines4 7#g7 ,an assessment of the impact of a community care network in the ,republic of the ,philippines on the timeliness of reimbursement of providers under the ,foreign ,medical ,program4 7#h7 ,such other elements as the ,secretary considers appropriate4 7c7 ,foreign ,medical ,program defined ,in this section1 the term ,foreign ,medical ,program means the program under which the ,secretary of ,veterans ,affairs provides hospital care and medical services under section #agbd of title #ch1 ,united ,states ,code4 #aac4 ,pilot program on consolidating the community care dental treatment plan approval process of ,department of ,veterans ,affairs 7a7 ,in general ,commencing not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall carry out a two-year pilot program 7in this section referred to as the pilot program7 to test the efficacy of-- 7#a7 hiring general dentists at the facility level to manage approval by the ,department of ,veterans ,affairs of treatment plans requested by dental providers in providing community care2 and 7#b7 hiring dental specialists at the ,veterans ,integrated ,service ,network level to aid in approving treatment plans for specialty dental care requested by dental providers in providing community care4 7b7 ,locations ,the ,secretary shall select not fewer than two ,veterans ,integrated ,service ,networks of the ,department at which to carry out the pilot program4 7c7 ,reports 7#a7 ,initial report ,not later than one year after the commencement of the pilot program1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the pilot program1 including-- 7,a7 an identification of the ,veterans ,integrated ,service ,networks participating in the pilot program2 7,b7 a description of the implementation of the pilot program2 7,c7 an identification of any barriers or challenges to implementing the pilot program2 7,d7 aggregated feedback with respect to the pilot program from dentists of the ,department in ,veterans ,integrated ,service ,networks participating in the pilot program2 and 7,e7 aggregated feedback from dental providers providing community care within ,veterans ,integrated ,service ,networks participating in the pilot program regarding any changes in the timeliness of treatment plan approvals by the ,department4 7#b7 ,final report ,not later than #ij days before the completion of the pilot program1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the pilot program that-- 7,a7 includes the matters required under paragraph 7#a72 7,b7 includes recommendations on whether the pilot program should be continued or adopted throughout the ,department2 and 7,c7 indicates whether the ,secretary requests action by ,congress to make the pilot program permanent4 7d7 ,community care defined ,in this section1 the term community care means dental care provided-- 7#a7 under section #agjc of title #ch1 ,united ,states ,code2 or 7#b7 pursuant to a ,veterans ,care ,agreement under section #agjc;,a of such title4 #aad4 ,reviews of payment rate waivers under ,veterans ,community ,care ,program 7a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 and annually thereafter1 the ,secretary of ,veterans ,affairs shall-- 7#a7 conduct a review of payment rate waivers for third party administrators under the ,veterans ,community ,care ,program under section #agjc of title #ch1 ,united ,states ,code1 to identify whether those waivers are helping to alleviate community-specific challenges1 including scarcity of medical services associated with access to care2 and 7#b7 submit to ,congress a report on the results of the review4 7b7 ,inclusion in rate review ,each review required under subsection 7a7 shall include-- 7#a7 a review of the total number of payment rate waivers requested for each region1 including the number granted1 denied1 or withdrawn2 7#b7 the process for review of payment rate waivers2 7#c7 the average time to process payment rate waivers in each region2 7#d7 the impact of payment rate waivers granted in a region on access to care in that region2 and 7#e7 trends identified by the ,secretary with respect to payment rate waivers4 #aae4 ,comptroller ,general report on dentistry under ,veterans ,community ,care ,program ,not later than one year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on dental care furnished by the ,secretary of ,veterans ,affairs under the ,veterans ,community ,care ,program under section #agjc of title #ch1 ,united ,states ,code1 to include a review of-- 7#a7 the impact current reimbursement rates provided by the ,department of ,veterans ,affairs to dental providers under such program have on-- 7,a7 the availability of dental care for veterans2 and 7,b7 the ability of third party administrators of provider networks under such program to meet their contractual obligations for network adequacy2 7#b7 the satisfaction of dental providers providing dental care under such program with the processes of the ,department for approving dental care under such program2 and 7#c7 the current processes of the ,department for approving emergent dental care under such program4 ,,ii ,health care employees #bja4 ,establishment of ,start and ,stay at ,,va program 7a7 ,in general ,chapter #gf of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new subchapter3 ,x ,start and ,stay at ,,va ,program #gfii;,c4 ,start and ,stay at ,,va ,program 7a7 ,in general ,as part of the ,educational ,assistance ,program1 the ,secretary shall carry out a program under this subchapter to provide-- 7#a7 scholarships under section #gfii;,c-#a of this title2 and 7#b7 lump sum education debt reduction under section #gfii;,c-#b of this title4 7b7 ,name of program ,the program under this subchapter shall be known as the ,start and ,stay at ,,va ,program 7in this subchapter referred to as the ,program74 #gfii;,c-#a4 ,scholarships 7a7 ,covered costs ,a scholarship provided to an individual under the ,program shall consist of payment of reasonable education expenses of the individual for a course of education or training described in subsection 7b77#c71 including tuition1 fees1 books1 and laboratory expenses4 7b7 ,eligibility ,an individual is eligible to receive a scholarship under the ,program if the individual-- 7#a7 is an employee of the ,department serving as a medical support assistant1 advanced medical support assistant1 lead medical support assistant1 or supervisory medical support assistant2 7#b7 as of the date on which the individual submits an application for participation in the ,program1 has been continuously employed by the ,department in one or more of the positions specified in paragraph 7#a7 for a period of not less than two years2 7#c7 has been accepted for enrollment or is enrolled as a student in a course of education or training-- 7,a7 listed as a requirement for any shortage occupation position1 as determined by the ,secretary2 7,b7 related to business1 health care administration1 or human resources2 or 7,c7 completion of which results in any other degree or certification that the ,secretary considers appropriate for purposes of the ,program2 and 7#d7 has a record of employment with the ,department that1 in the judgment of the ,secretary1 demonstrates a high likelihood that the individual will be successful in completing such course of education or training and in gaining employment in a field related to such course of education or training4 7c7 ,period of obligated service 7#a7 ,agreement 7,a7 ,in general ,an agreement between the ,secretary and a participant under the ,program who seeks a scholarship under this section1 in addition to the requirements set forth in section #gfjd of this title1 shall include the following3 7i7 ,the agreement of the ,secretary to provide the participant with a scholarship under the ,program for a specified number of school years1 which may not exceed the credit equivalent of four full school years1 during which the participant pursues a course of education or training described in subsection 7b77#c7 that meets the requirements set forth in section #gfjb7;a7 of this title4 7ii7 ,subject to subparagraph 7,b71 the agreement of the participant to serve as a full-time employee in the ,department in a position described in subsection 7b77#c77;,a7 for a period of time1 not less than one year1 that is equal to the period of the course of education or training for which a scholarship is provided under this section 7in this section referred to as the period of obligated service of the participant74 7,b7 ,part-time students ,in the case of a participant who is a part-time student during a school year with respect to which a scholarship is provided to the participant under this section1 the period of obligated service of the participant incurred during that school year shall be reduced in accordance with the proportion that the number of credit hours carried by the participant in that school year bears to the number of credit hours required to be carried by a full-time student in the course of education or training pursued by the participant during that school year1 but in no event may the total period of obligated service of the participant be reduced to less than one year4 7#b7 ,service commencement date 7,a7 ,in general ,except as provided in subparagraph 7,f7 of 7,g71 not later than #fj days before the service commencement date of a participant under this section1 the ,secretary shall notify the participant of that service commencement date4 ,that date is the beginning of the period of obligated service of the participant4 7,b7 ,doctors and similar health care professionals ,in the case of a participant receiving a degree from a school of medicine1 osteopathy1 dentistry1 optometry1 or podiatry1 the service commencement date of the participant is the date the participant becomes licensed to practice medicine1 osteopathy1 dentistry1 optometry1 or podiatry1 as the case may be1 in a ,state4 7,c7 ,nurses ,in the case of a participant receiving a degree from a school of nursing1 the service commencement date of the participant is the later of-- 7i7 the course completion date of the participant2 or 7ii7 the date the participant becomes licensed as a registered nurse in a ,state4 7,d7 ,other health care professionals ,in the case of a participant not covered by subparagraph 7,b7 or 7,c71 the service commencement date of the participant is the later of-- 7i7 the course completion date of the participant2 or 7ii7 the date the participant meets any applicable licensure or certification requirements4 7,e7 ,treatment of part-time students ,the ,secretary shall specify the service commencement date for participants who were part-time students1 which shall include terms as similar as practicable to the terms set forth in subparagraphs 7,b7 through 7,d74 7,f7 ,service during course of education or training ,a participant may serve the period of obligated service of the participant1 or any portion of such period of obligated service1 during the period in which the participant is enrolled as a student in a course of education or training under subsection 7b77#c7 if the participant is employed in a position described in subparagraph 7,a7 of such subsection4 7,g7 ,service following licensure or ongoing training ,with respect to a participant who is licensed but may enter a residency or similar training program1 the ,secretary may adjust the beginning of the period of obligated service of the participant to begin following completion of the residency or similar training program4 7,h7 ,course completion date defined ,in this section1 the term course completion date means the date on which a participant under this section completes the course of education or training of the participant under this section4 7d7 ,liability for breach of agreement 7#a7 ,liability during course of education or training 7,a7 ,in general ,except as provided in paragraph 7#c71 a participant under this section shall be liable to the ,united ,states for the amount that has been paid to or on behalf of the participant under the agreement under subsection 7c77#a7 if any of the following occurs3 7i7 ,the participant fails to maintain an acceptable level of academic standing in the educational institution in which the participant is enrolled 7as determined by the educational institution pursuant to direction by the ,secretary74 7ii7 ,the participant is dismissed from such educational institution for disciplinary reasons4 7iii7 ,the participant voluntarily terminates the course of education or training in such educational institution before the completion of such course of education or training4 7iv7 ,the participant1 as applicable1 during a period of time determined by the ,secretary-- 7,i7 fails to become licensed to practice medicine1 osteopathy1 dentistry1 podiatry1 or optometry in a ,state2 7,,ii7 fails to become licensed as a registered nurse in a ,state2 or 7,,iii7 in the case of any other health-care personnel who is not covered under subclause 7,i7 or 7,,ii71 fails to meet any applicable licensure or certification requirement4 7,b7 ,in lieu of service obligation ,liability under this paragraph is in lieu of any period of obligated service arising under the agreement of the participant under subsection 7c77#a74 7#b7 ,liability during period of obligated service ,except as provided in paragraph 7#c71 if a participant under this section breaches the agreement under subsection 7c77#a7 by failing for any reason to complete the period of obligated service of the participant1 the ,united ,states shall be entitled to recover from the participant an amount equal to-- 7,a7 the total amount paid under this section to the participant2 multiplied by 7,b7 a fraction-- 7i7 the numerator of which is-- 7,i7 the total number of months in the period of obligated service of the participant2 minus 7,,ii7 the number of months served by the participant2 and 7ii7 the denominator of which is the total number of months in the period of obligated service of the participant4 7#c7 ,limitation on liability for reduction in force ,liability shall not arise under paragraph 7#a7 or 7#b7 in the case of a individual covered by either such paragraph if the individual does not obtain1 or fails to maintain1 employment as an employee of the ,department due to staffing changes approved by the ,secretary4 7e7 ,payment of amounts and limitations 7#a7 ,total amount for a school year ,the total amount of a scholarship payable to a participant under this section-- 7,a7 may not exceed #bj1jjj for the equivalent of one year of full-time coursework in a course of education or training2 or 7,b7 in the case of a participant who is a part-time student1 may not exceed an amount that bears the same ratio to the amount that would be paid under subparagraph 7,a7 if the student were a full-time student in the course of education or training being pursued by the participant as the coursework carried by the participant compares to full-time coursework in that course of education or training4 7#b7 ,maximum number of school years 7,a7 ,total years ,the number of school years for which a scholarship may be paid to a participant under this section may not exceed eight school years4 7,b7 ,full-time equivalent ,a participant may not receive a scholarship under this section for more than the equivalent of four years of full-time coursework4 7#c7 ,maximum total amount ,the total amount paid to or on behalf of a participant through a scholarship under this section may not exceed #hj1jjj4 7#d7 ,payment of educational expenses by educational institutions ,the ,secretary may arrange with an educational institution in which a participant under this section is enrolled for the payment of education expenses under subsection 7a74 ,such payments may be made without regard to subsections 7a7 and 7b7 of section #ccbd of title #ca4 #gfii;,c-#b4 ,lump sum education debt reduction 7a7 ,covered costs ,lump sum education debt reduction provided by the ,secretary under this section to an individual shall consist of payment of principal and interest under a loan1 the proceeds of which were used by or on behalf of that individual to pay costs relating to a course of education or training1 including tuition expenses and other reasonable educational expenses1 including fees1 books1 laboratory expenses1 and reasonable living expenses4 7b7 ,eligibility ,an individual is eligible to receive lump sum education debt repayment under this section if the individual-- 7#a7 owes any amount of principal and interest under a loan1 the proceeds of which were used by or on behalf of that individual to pay costs relating to a course of education or training2 7#b7 commits to a period of obligated service under subsection 7d72 and 7#c7 has been offered employment in the ,department in the position of a medical support assistant1 advanced medical support assistant1 lead medical support assistant1 or supervisory medical support assistant4 7c7 ,payments 7#a7 ,in general ,a lump sum education debt reduction payment under this section shall consist of a payment to a participant under this section of an amount not to exceed the lesser of-- 7,a7 the principal and interest on loans described in subsection 7a7 that is outstanding for such participant at the time of the payment2 or 7,b7 #dj1jjj4 7#b7 ,proof of use of amounts ,participants under this section in receipt of a lump sum education debt reduction payment under this section must provide proof of payment verifying the full lump sum payment received was paid to the lender for the loan held by such participant not later than #de days after receiving the lump sum payment4 7d7 ,period of obligated service 7#a7 ,in general ,in exchange for a one-time lump sum education debt payment under this section1 a participant under this section shall agree to be employed for not less than three years at the ,department 7in this section referred to as the period of obligated service74 7#b7 ,positions of employment 7,a7 ,medical support ,not fewer than two of the years of the period of obligated service of a participant under this section shall be served in the position of medical support assistant1 advanced medical support assistant1 lead medical support assistant1 or supervisory medical support assistant of the ,department4 7,b7 ,hard-to-hire or hard-to-recruit ,the remainder of any period of obligated service not covered under subparagraph 7,a7 shall be served in a hard-to-hire or hard-to-recruit position as determined by the ,secretary4 7e7 ,liability during period of obligated service 7#a7 ,in general ,except as provided in paragraph 7#b71 if a participant under this section fails to complete the period of obligated service of the participant for any reason1 the ,united ,states shall be entitled to recover from the participant an amount equal to-- 7,a7 the total amount paid under this section to the participant2 multiplied by 7,b7 a fraction-- 7i7 the numerator of which is-- 7,i7 the total number of months in the period of obligated service of the participant2 minus 7,,ii7 the number of months served by the participant2 and 7ii7 the denominator of which is the total number of months in the period of obligated service of the participant4 7#b7 ,exception ,liability shall not arise under paragraph 7#a7 in the case of an individual covered by that paragraph if the individual does not obtain1 or fails to maintain1 employment as an employee of the ,department due to staffing changes approved by the ,secretary4 #gfii;,c-#c4 ,administration 7a7 ,outreach 7#a7 ,in general ,the ,secretary shall develop an outreach program to ,tribal ,colleges and ,universities1 historically ,black colleges and universities1 high schools in rural areas1 community colleges1 transition assistance programs for members of the ,armed ,forces transitioning to civilian life1 and spouses of such members to provide information about the ,program4 7#b7 ,tribal ,college or ,university defined ,in this subsection1 the term ,tribal ,college or ,university has the meaning given that term under section #caf of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajei;c74 7b7 ,mentors ,the ,secretary shall ensure that a mentor or mentors are available for each individual participating in the ,program at the facility at which the individual is employed4 #gfii;,c-#d4 ,limitation ,no individual may receive both a scholarship under section #gfii;,c-#a of this title and a lump sum education debt reduction under section #gfii;,c-#b of this title4 #gfii;,c-#e4 ,termination ,the authority to carry out the ,program shall terminate on the date that is #aj years after the date of the enactment of the ,making ,community ,care ,work for ,veterans ,act of #bjbc4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by adding at the end the following3 ,,subchapter ,x--,start and ,stay at ,,va ,program ,sec4 #gfii;,c4 ,start and ,stay at ,,va ,program4 #gfii;,c-#a4 ,scholarships4 #gfii;,c-#b4 ,lump sum education debt reduction4 #gfii;,c-#c4 ,administration4 #gfii;,c-#d4 ,limitation4 #gfii;,c-#e4 ,termination4 4 7c7 ,conforming amendments 7#a7 ,establishment of program ,section #gfja7;a7 of such title is amended-- 7,a7 in paragraph 7#f71 by striking and2 7,b7 in paragraph 7#g71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following new paragraph3 7#h7 the program to provide scholarships and lump sum education debt reduction provided for in subchapter ,x of this chapter4 4 7#b7 ,eligibility ,section #gfjb of such title is amended-- 7,a7 in subsection 7a77#a7-- 7i7 by striking or ,,ix and inserting ,,ix1 or ,x2 7ii7 by striking or for which a scholarship and inserting for which a scholarship2 and 7iii7 by inserting or for which a scholarship or lump sum education debt reduction may be provided under subchapter ,x of this chapter1 before as the case may be2 and 7,b7 in subsection 7b71 by striking or ,,ix and inserting ,,ix1 or ,x4 7#c7 ,application ,section #gfjc7;a77#a7 of such title is amended by striking or ,,ix and inserting ,,ix1 or ,x4 7#d7 ,terms of agreement ,section #gfjd of such title is amended by striking or ,,ix each place it appears and inserting ,,ix1 or ,x4 7#e7 ,annual report ,section #gfcb of such title is amended-- 7,a7 in paragraph 7#a71 by striking and the ,readjustment ,counseling ,service ,scholarship ,program and inserting the ,readjustment ,counseling ,service ,scholarship ,program1 and the ,start and ,stay at ,,va ,program2 and 7,b7 in paragraph 7#d71 by striking and per participant in the ,readjustment ,counseling ,service ,scholarship ,program and inserting per participant in the ,readjustment ,counseling ,service ,scholarship ,program1 and per participant in the ,start and ,stay at ,,va ,program4 #bjb4 ,expansion of period of payment under ,employee ,incentive ,scholarship ,program ,section #gfgc7;c7 of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in paragraph 7#a7 by striking six and inserting eight2 and 7#b7 in paragraph 7#b7 by striking three and inserting four4 #bjc4 ,mentorship program for executive leadership teams at medical centers of the ,department of ,veterans ,affairs 7a7 ,in general ,the ,secretary of ,veterans ,affairs may establish a program to connect covered individuals 7in this section referred to as mentees7 with peer mentors to facilitate sharing of best practices and leadership experiences and to foster opportunities to develop knowledge and skills required to lead successfully at medical facilities of the ,department 7in this section referred to as the mentorship program74 7b7 ,covered individual defined ,in this section1 the term covered individual means-- 7#a7 an individual in the position of ,facility ,director1 ,chief of ,staff1 ,associate ,director of ,patient ,care ,services1 ,associate ,director1 ,assistant ,director1 or ,deputy ,director at a medical center of the ,department2 or 7#b7 any other employee of the ,department who is determined by the ,secretary to be an executive leader at a medical center of the ,department4 7c7 ,eligibility ,the following employees of the ,department are eligible for participation as mentees in the mentorship program3 7#a7 ,an employee appointed to a position as a covered individual on or after the date of the enactment of this ,act4 7#b7 ,a covered individual employed at a medical center of the ,department 7regardless of appointment commencement date7 that meets one or more of the following criteria3 7,a7 ,reports poor performance1 as defined by the ,secretary1 on the ,strategic ,analytics for ,improvement and ,learning ,value ,model of the ,department1 or successor similar model4 7,b7 ,reports data under section #agjc;,c7a77#c7 of title #ch1 ,united ,states ,code1 as published on the ,access to ,care website of the ,department1 or successor similar website1 that-- 7i7 does not consistently meet the level reported in the community surrounding such medical center1 as determined by the ,secretary2 or 7ii7 does not meet a threshold level determined by the ,secretary4 7,c7 ,has one or more recommendations from a report by the ,office of ,inspector ,general of the ,department of ,veterans ,affairs that is still open more than one year after the report was published4 7#c7 ,a covered individual employed at a medical center of the ,department 7regardless of appointment commencement date7 who is recommended by the director of the ,veterans ,integrated ,service ,network overseeing such medical center4 7d7 ,criteria for peer mentors ,each peer mentor to be paired with a mentee under subsection 7a7 shall meet each of the following criteria3 7#a7 ,previous or current employment in the same position title as the mentee4 7#b7 ,employment in that position for not less than two years4 7#c7 ,employment at a medical center of the ,department that reports-- 7,a7 above average performance1 as defined by the ,secretary1 on the ,strategic ,analytics for ,improvement and ,learning ,value ,model of the ,department1 or successor similar model2 and 7,b7 data under section #agjc;,c7a77#c7 of title #ch1 ,united ,states ,code1 as published on the ,access to ,care website of the ,department1 or successor similar website1 that exceeds the level reported in the community surrounding such medical center1 as determined by the ,secretary4 7e7 ,report ,not later than one year after the date of the enactment of this ,act1 and annually thereafter for an additional three years1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the mentorship program1 including-- 7#a7 the number of mentees and peer mentors participating in the mentorship program1 disaggregated by medical center of the ,department2 7#b7 the number of mentor-mentee pairings initiated under each of the eligibility criteria outlined in paragraphs 7#a71 7#b71 and 7#c7 of subsection 7c71 including information on any circumstances in which multiple criteria under such paragraphs were met2 7#c7 a description of the actions taken by the ,department to encourage communication between mentees and peer mentors2 7#d7 aggregated feedback from participants in the mentorship program2 and 7#e7 the turnover rate for covered individuals4 ,,iii ,other health care matters #cja4 ,timing for scheduling of appointments at facilities of ,department of ,veterans ,affairs 7a7 ,in general ,subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 is amended by inserting after section #agjf;,a the following new section3 #agjf;,b4 ,requirements for timing of scheduling of appointments at ,department facilities ,the ,secretary shall ensure that an appointment for a veteran for care or services under this chapter from a facility of the ,department-- 7#a7 in the case of a non-urgent appointment1 is scheduled 7but may occur at a later date7 not later than seven days after the earlier of the date on which-- 7,a7 a clinician of the ,department determines that the veteran requires care2 or 7,b7 the veteran presents to the ,department requesting care2 and 7#b7 in the case of an appointment for urgent care1 is completed not later than #dh hours after the earlier of the date on which-- 7,a7 a clinician of the ,department determines that the veteran requires care2 or 7,b7 the veteran presents to the ,department requesting care4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such subchapter is amended by inserting after the item relating to section #agjf;,a the following new item3 #agjf;,b4 ,requirements for timing of scheduling of appointments at ,department facilities4 4 7c7 ,effective date ,the ,secretary of ,veterans ,affairs shall comply with the requirements under section #agjf;,b of title #ch1 ,united ,states ,code1 as added by subsection 7a71 by not later than #ahj days after the date of the enactment of this ,act4 #cjb4 ,modification of requirements for standards for quality of care from ,department of ,veterans ,affairs 7a7 ,in general ,subsection 7a7 of section #agjc;,c of title #ch1 ,united ,states ,code1 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 by striking ,in establishing and inserting 7,a7 ,in establishing2 and 7,b7 by adding at the end the following new subparagraph3 7,b7 ,the ,secretary shall ensure that the standards for quality established under paragraph 7#a7 are comparable to industry standards to ensure there is adequate data transference between care furnished by the ,department and care furnished by a non-,department provider4 2 7#b7 in paragraph 7#c7-- 7,a7 in subparagraph 7,a71 by striking 2 and and inserting a semicolon2 7,b7 in subparagraph 7,b7-- 7i7 in the matter preceding clause 7i71 by striking to the following3 and inserting to--2 7ii7 in clause 7i7-- 7,i7 by striking ,timely and inserting timely2 and 7,,ii7 by striking the period at the end and inserting a semicolon2 7iii7 in clause 7ii7-- 7,i7 by striking ,effective and inserting effective2 and 7,,ii7 by striking the period at the end and inserting a semicolon2 7iv7 in clause 7iii7-- 7,i7 by striking ,safety and inserting safety2 and 7,,ii7 by striking the period at the end and inserting a semicolon2 7v7 in clause 7iv7-- 7,i7 by striking ,efficiency and inserting efficiency2 and 7,,ii7 by striking the period at the end and inserting 2 and2 and 7vi7 by adding at the end the following new clause3 7v7 equitable care2 and 2 and 7,c7 by adding at the end the following new subparagraph3 7,c7 measurements of standards for quality that include measurements of-- 7i7 the degree to which care is furnished uniquely to patient needs2 7ii7 workforce safety2 7iii7 employee engagement2 7iv7 safety culture2 7v7 outcomes on patient quality of life2 and 7vi7 such other matters as the ,secretary considers appropriate4 2 7#c7 in paragraph 7#d71 by striking and the ,centers for ,medicare ,medicaid ,services and inserting the ,centers for ,medicare ,medicaid ,services1 and the ,indian ,health ,service2 and 7#d7 by striking paragraph 7#e7 and inserting the following new paragraphs3 7#e7 ,when collecting1 considering1 and applying data related to patient care for purposes of establishing standards for quality under paragraph 7#a71 the ,secretary shall ensure no metric is being over or under analyzed4 7#f7 ,in establishing standards for quality under paragraph 7#a71 the ,secretary shall-- 7,a7 utilize the most current practices in extracting and analyzing relevant data2 7,b7 utilize all relevant data available to the ,secretary2 7,c7 ensure the most efficient use of time and resources related to the use of data scientists employed by the ,department2 and 7,d7 collaborate1 as appropriate1 with entities specified in paragraph 7#d74 7#g7 7,a7 ,not later than five years after the submittal of the report required by section #cjb7;d77#b77;,b7 of the ,making ,community ,care ,work for ,veterans ,act of #bjbc1 and not less frequently than once every five years thereafter1 the ,secretary shall update the standards for quality established under paragraph 7#a7 pursuant to the requirements for the establishment of such standards under this subsection4 7,b7 ,not later than #cj days after any update under subparagraph 7,a7 of standards for quality established under paragraph 7#a71 the ,secretary shall submit to the appropriate committees of ,congress a report on such updated standards for quality4 4 7b7 ,publication and consideration of public comments ,subsection 7b7 of such section is amended-- 7#a7 in paragraph 7#a7-- 7,a7 by striking ,not later than #a year after the date on which the ,secretary establishes standards for quality under subsection 7a7 and inserting ,not less frequently than once every three years2 and 7,b7 by inserting pursuant to standards for quality under subsection 7a7 after medical facilities of the ,department2 and 7#b7 in paragraph 7#b71 by inserting or updates after establishes4 7c7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to the appropriate committees of ,congress a report on-- 7#a7 how the ,secretary has consulted with entities specified in paragraph 7#d7 of section #agjc;,c7a7 of title #ch1 ,united ,states ,code1 before the date of the enactment of this ,act in establishing standards for quality under such section2 7#b7 how the ,secretary has continued to consult with those entities on and after such date of enactment2 and 7#c7 how the ,secretary intends to leverage data sciences to improve standards for quality care furnished by the ,department of ,veterans ,affairs4 7d7 ,initial update to quality care metrics 7#a7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall submit to the appropriate committees of ,congress a report on how the ,secretary plans to implement the amendments made by subsections 7a7 and 7b74 7#b7 ,implementation ,not later than two years after the date of the enactment of this ,act1 the ,secretary shall-- 7,a7 implement the amendments made by subsections 7a7 and 7b71 including by updating the standards for quality established under section #agjc;,c7a77#a7 of title #ch1 ,united ,states ,code2 and 7,b7 submit to the appropriate committees of ,congress a report detailing the standards for quality updated pursuant to such amendments4 7e7 ,appropriate committees of ,congress defined ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 #cjc4 ,mental ,health ,residential ,rehabilitation ,treatment ,program of the ,department of ,veterans ,affairs 7a7 ,general requirements 7#a7 ,deadline ,the ,secretary of ,veterans ,affairs shall fulfill each requirement under this section by not later than one year after the date of the enactment of this ,act1 unless otherwise specified4 7#b7 ,guidance ,the ,secretary shall update the guidance of the ,department of ,veterans ,affairs on the operation of the ,mental ,health ,residential ,rehabilitation ,treatment ,program 7in this section referred to as the ,program7 to reflect each of the requirements under subsections 7b7 through 7h74 7b7 ,referral and admission 7#a7 ,referral 7,a7 ,standardized process ,the ,secretary shall establish a standardized consultation requirement or other process for referrals to the ,program4 7,b7 ,timeliness standards ,the ,secretary shall specify timeliness standards for responding to referrals and completing screenings for the ,program1 including for when priority admission is requested1 from-- 7i7 providers of the ,department2 7ii7 non-,department providers2 and 7iii7 veteran patients 7self-referrals74 7#b7 ,screening of priority veterans 7,a7 ,in general ,for any veteran who meets priority admission standards under the ,program during a screening for the ,program1 the ,secretary shall admit the veteran not later than #gb hours after the time at which the veteran was screened4 7,b7 ,other admission options ,with respect to a veteran specified in subparagraph 7,a71 if there are no available bed spaces for admission under the ,program at the facility of the ,department or within the ,veterans ,integrated ,service ,network nearest to the residence of the veteran within the #gb-;hour period specified in such subparagraph1 the ,secretary shall offer the veteran a choice of care-- 7i7 at another facility of the ,department anywhere in the ,united ,states that can admit the veteran within such period2 or 7ii7 at a non-,department residential care facility in the community that can admit the veteran within such period and-- 7,i7 has a contract or agreement with the ,department in place2 or 7,,ii7 will enter into such a contract or agreement prior to furnishing such care4 7#c7 ,admission ,the ,secretary shall specify timeliness standards for the admission of a veteran into the ,program1 or the referral of a veteran to a non-,department residential care facility in the community1 upon making an admission decision with respect to the veteran4 7#d7 ,performance metrics 7,a7 ,in general ,the ,secretary shall develop metrics to track1 and shall subsequently track1 the performance of the ,department1 and contractors of the ,department that provide residential care to veterans1 in meeting-- 7i7 the requirements for referral to the ,program under paragraph 7#a7 and any other provision of law2 7ii7 the requirements for screening for the ,program and other admission options under paragraph 7#b72 and 7iii7 the requirements for timely admission to the ,program under paragraph 7#c74 7,b7 ,elements ,the metrics developed under subparagraph 7,a7 shall include metrics for tracking performance with respect to routine and priority access under the ,program4 7c7 ,placement2 transportation 7#a7 ,locations2 start dates ,if the ,secretary determines that a veteran is in need of residential care under the ,program1 the ,secretary shall provide the veteran with a list of locations that meet-- 7,a7 the care needs of the veteran1 including applicable treatment tracks2 and 7,b7 the clinically indicated best start date for the veteran to receive care1 taking into account the preferences of the veteran4 7#b7 ,wait times ,the ,secretary shall make every effort to limit the time a veteran waits for placement into the ,program1 including by offering the veteran placement at one or more locations outside of the area of the home facility of the veteran or the home ,veterans ,integrated ,service ,network of the veteran1 or at a non-,department residential care facility1 if there are no other options that meet the care needs of the veteran and are consistent with the policy of the ,department on wait times for access to care under the ,program4 7#c7 ,transportation coverage ,the ,secretary shall provide transportation or pay for or reimburse the costs of transportation for any veteran who is admitted into the ,program and needs transportation assistance-- 7,a7 from the residence of the veteran or a facility of the ,department or authorized non-,department facility that does not provide such care to another such facility that provides residential care covered under the ,program2 and 7,b7 back to the residence of the veteran after the conclusion of the ,program1 if applicable4 7d7 ,considerations ,in making screening1 admission1 and placement decisions under the ,program1 the ,secretary shall consider the input and preferences of the veteran and the treating clinicians of the veteran1 including with respect to wait times1 the program specialty1 subtype1 or treatment track offered to the veteran1 and the geographic placement of the veteran1 including family- or occupation-related preferences or circumstances4 7e7 ,appeals 7#a7 ,in general ,the ,secretary shall develop a national policy and associated procedures under which a veteran1 a representative of a veteran1 or a provider who refers a veteran to the ,program1 including a provider of the ,department or a non-,department provider1 may file an appeal if the veteran is denied admission into the ,program or is accepted into the ,program but is not offered bed placement in a timely manner4 7#b7 ,timeliness standards for review 7,a7 ,in general ,the national policy and procedures developed under paragraph 7#a7 for appeals described in such paragraph shall include timeliness standards for the ,department to review and make a decision on such an appeal4 7,b7 ,priority admission ,the ,secretary shall review and respond to all appeals related to priority admission to the ,program not later than #gb hours after receiving the appeal4 7,c7 ,routine admission ,the ,secretary shall review and respond to all appeals related to routine admission to the ,program not later than five business days after receiving the appeal4 7#c7 ,public guidance ,the ,secretary shall develop1 and make available to the public1 guidance on how a veteran1 a representative of the veteran1 or a referring provider of the veteran can file an appeal-- 7,a7 if the veteran is denied admission into the ,program2 7,b7 if the veteran is admitted into the ,program and the first date on which the veteran may enter the ,program does not comply with the wait time standards established by the ,department and under this section for purposes of priority or routine admission into the ,program2 or 7,c7 with respect to such other factors as the ,secretary may specify4 7f7 ,tracking of availability and wait times 7#a7 ,in general ,the ,secretary shall create a method for tracking availability and wait times under the ,program across all facilities and ,veterans ,integrated ,service ,networks of the ,department throughout the ,united ,states4 7#b7 ,availability of information ,the ,secretary shall make the information tracked under paragraph 7#a7 available in real time to-- 7,a7 the mental health treatment coordinators at each facility of the ,department2 7,b7 the leadership of each medical center of the ,department2 7,c7 the leadership of each ,veterans ,integrated ,service ,network2 and 7,d7 the ,office of the ,under ,secretary for ,health of the ,department4 7g7 ,training and oversight 7#a7 ,training 7,a7 ,in general ,the ,secretary shall update and implement training for all staff of the ,department involved in the ,program regarding referrals1 screening1 admission1 placement decisions1 and appeals for the ,program1 including all changes to processes and guidance under the ,program required by this section4 7,b7 ,veterans awaiting admission ,the training under subparagraph 7,a7 shall include procedures for the care of veterans awaiting admission into the ,program and communication with such veterans and their referring providers4 7,c7 ,timing of training 7i7 ,in general ,the ,secretary shall require the training under subparagraph 7,a7 to be completed by staff required to complete such training-- 7,i7 upon being first employed in a position that includes work involving the ,program2 and 7,,ii7 not less frequently than annually4 7ii7 ,tracking ,the ,secretary shall track completion of training required under clause 7i7 by staff required to complete such training and ensure its completion as required under such clause4 7#b7 ,oversight standards ,the ,secretary shall review and revise oversight standards for the leadership of the ,veterans ,integrated ,service ,networks to ensure that facilities and staff of the ,department are adhering to the policy of the ,program on access to care4 7h7 ,care coordination and follow-,up care 7#a7 ,continuity of care ,the ,secretary shall ensure each veteran who is screened for admission to the ,program is offered1 and provided if agreed upon1 care options during the period between screening of the veteran and admission of the veteran to the ,program to ensure the veteran does not experience any lapse in care4 7#b7 ,care coordination for substance use disorder ,for a veteran being treated for substance use disorder1 the ,secretary shall-- 7,a7 ensure there is a care plan in place during the period between any detoxification services or inpatient care received by the veteran and admission of the veteran to the ,program2 and 7,b7 communicate that care plan to the veteran1 the primary care provider of the veteran1 and the facility of the ,program where the veteran is or will be residing4 7#c7 ,care planning prior to discharge 7,a7 ,in general ,the ,secretary1 in consultation with the veteran and the treating providers of the veteran in the ,program1 shall ensure the completion of a care plan prior to the veteran being discharged from the ,program4 7,b7 ,matters ,to be included ,the care plan required under subparagraph 7,a7 for a veteran shall include details on the course of treatment for the veteran following completion of treatment under the ,program1 including any needed follow-up care4 7,c7 ,sharing of care plan ,the care plan required under subparagraph 7,a7 shall be shared with the veteran1 the primary care provider of the veteran1 and any other providers with which the veteran consents to sharing the plan4 7,d7 ,discharge from non-,department facility ,upon discharge of a veteran under the ,program from a non-,department facility1 the facility shall share with the ,department all care records maintained by the facility with respect to the veteran and shall work in consultation with the ,department on the care plan of the veteran required under subparagraph 7,a74 7i7 ,reports to ,congress 7#a7 ,report on changes made to ,program 7,a7 ,in general ,not later than two years after the date of the enactment of this ,act1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on changes made to the guidance1 operation1 and oversight of the ,program to fulfill the requirements of this section4 7,b7 ,funding ,the report required by subparagraph 7,a7 shall-- 7i7 examine how care provided to veterans under the ,program is funded1 including care provided through-- 7,i7 facilities of the ,department2 and 7,,ii7 non-,department facilities2 7ii7 assess whether costs of the ,program1 including for residential care provided through facilities of the ,department and non-,department facilities1 serve as a disincentive to placement in the ,program2 7iii7 identify the average cost of a stay under the ,program1 including total stay average and daily average1 at-- 7,i7 a facility of the ,department2 and 7,,ii7 a non-,department facility2 and 7iv7 include such recommendations as the ,secretary may have for legislative or administrative action to address any funding constraints or disincentives for use of the ,program4 7,c7 ,actions taken to address recommendations 7i7 ,in general ,the ,secretary shall include with the report required by subparagraph 7,a7 a description of actions taken by the ,department to address the findings and recommendations by the ,secretary contained in the report under section #ejc7;c7 of the ,,strong ,veterans ,act of #bjbb 7division ,v of ,public ,law #aag-cbh74 7ii7 ,actions ,to be included ,actions to be included under clause 7i7 shall include-- 7,i7 any new locations of the ,program added2 7,,ii7 any beds added at existing facilities of the ,program2 and 7,,iii7 any additional treatment tracks or gender-specific programs created or added at facilities of the ,department4 7#b7 ,annual report on operation of ,program 7,a7 ,in general ,not later than one year after submitting the report required by paragraph 7#a77;,a71 and not less frequently than annually thereafter1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the operation of the ,program4 7,b7 ,elements ,each report required by subparagraph 7,a7 shall include the following3 7i7 ,the number of veterans served by the ,program1 disaggregated by-- 7,i7 ,veterans ,integrated ,service ,network in which the veteran receives care2 7,,ii7 facility1 including facilities of the ,department and non-,department facilities1 at which the veteran receives care2 7,,iii7 type of residential rehabilitation treatment care received by the veteran under the ,program2 7,,iv7 gender of the veteran2 and 7,v7 race or ethnicity of the veteran4 7ii7 ,wait times under the ,program for the most recent year data is available1 disaggregated by-- 7,i7 treatment track or specificity of residential rehabilitation treatment care sought by the veteran2 7,,ii7 gender of the veteran2 7,,iii7 ,state or territory in which the veteran is located2 7,,iv7 ,veterans ,integrated ,service ,network in which the veteran is located2 and 7,v7 facility of the ,department at which the veteran seeks care4 7iii7 ,a list of all locations of the ,program and number of bed spaces at each such location1 disaggregated by residential rehabilitation treatment care or treatment track provided under the ,program at such location4 7iv7 ,a list of any new ,program locations added or removed and any bed spaces added or removed during the one-year period preceding the date of the report4 7v7 ,average cost of a stay under the ,program1 including total stay average and daily average1 at-- 7,i7 a facility of the ,department2 and 7,,ii7 a non-,department facility4 7vi7 ,a review of staffing needs and gaps with respect to the ,program4 7vii7 ,any recommendations for changes to the operation of the ,program1 including any policy changes1 guidance changes1 training changes1 or other changes4 7j7 ,government ,accountability ,office review on access to care under the ,program 7#a7 ,in general ,not later than two years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall review access to care under the ,program for veterans in need of residential mental health care and substance use disorder care4 7#b7 ,elements ,the review required by paragraph 7#a7 shall include the following3 7,a7 ,a review of wait times under the ,program1 disaggregated by-- 7i7 treatment track or specificity of residential rehabilitation treatment care needed2 7ii7 gender of the veteran2 7iii7 home ,state of the veteran2 7iv7 home ,veterans ,integrated ,service ,network of the veteran2 and 7v7 wait times for-- 7,i7 facilities of the ,department2 and 7,,ii7 non-,department facilities4 7,b7 ,a review of policy and training of the ,department on screening1 admission1 and placement under the ,program4 7,c7 ,a review of the rights of veterans and referring providers to appeal admission decisions under the ,program and how the ,department adjudicates appeals4 7,d7 ,a review of how the preferences of a veteran admitted to the ,program are taken into consideration when determining the facility at which the veteran will be placed in the ,program4 7,e7 ,a review of staffing and staffing needs and gaps of the ,program1 including with respect to-- 7i7 mental health providers and coordinators at the facility level2 7ii7 staff of ,program facilities2 and 7iii7 overall administration of the ,program at the national level4 7,f7 ,recommendations for improvement of access by veterans to care under the ,program1 including with respect to-- 7i7 any new sites or types of programs needed or in development2 7ii7 changes in training or policy2 7iii7 changes in communications with veterans2 and 7iv7 oversight of the ,program by the ,department4 7k7 ,definitions ,in this section3 7#a7 ,mental ,health ,residential ,rehabilitation ,treatment ,program ,the term ,mental ,health ,residential ,rehabilitation ,treatment ,program-- 7,a7 means the array of programs and services of the ,department that comprise residential care for mental health and substance use disorders2 and 7,b7 includes the programs designated as of the date of the enactment of this ,act as domiciliary residential rehabilitation treatment programs4 7#b7 ,treatment track ,the term treatment track means a specialized treatment program that is provided to a subset of veterans in the ,program who receive the same or similar intensive treatment and rehabilitative services4 7#c7 ,united ,states ,the term ,united ,states means the #ej ,states1 the ,district of ,columbia1 the ,commonwealth of ,puerto ,rico1 ,guam1 the ,virgin ,islands1 ,american ,samoa1 and any other commonwealth1 territory1 or possession of the ,united ,states4 #cjd4 ,electronic document submission option for the ,,champva program 7a7 ,online portal ,not later than #ah months after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall publish an online portal allowing-- 7#a7 individuals applying for medical care under section #agha of title #ch1 ,united ,states ,code1 the ability to-- 7,a7 submit application materials electronically2 7,b7 view the status of their application online2 and 7,c7 select their preferred method of communication regarding their application1 which the ,department of ,veterans ,affairs shall use upon their first attempt to contact the individual if there are any issues with their application2 7#b7 individuals applying for or receiving medical care under such section the ability to submit electronically-- 7,a7 documentation regarding other health insurance certification2 7,b7 documentation regarding school enrollment certification2 and 7,c7 any other documentation required to apply for or continue coverage under such section2 and 7#c7 individuals receiving medical care under such section and providers of medical care under such section the ability to-- 7,a7 submit medical claims documentation electronically2 7,b7 request reprocessing of a denied claim electronically2 and 7,c7 file a reconsideration or appeal of a claim electronically4 7b7 ,contract ,the ,secretary may enter into a contract with a non-,department entity to carry out subsection 7a74 7c7 ,outreach ,upon the implementation of the online portal required under subsection 7a71 the ,secretary shall conduct outreach to ensure individuals eligible for care under section #agha of title #ch1 ,united ,states ,code1 and providers of such care are aware of the portal4 7d7 ,rule of construction ,nothing in this section shall be construed to limit the ability of the ,secretary to collect application materials relating to medical care under section #agha of title #ch1 ,united ,states ,code1 by mail or by fax4 7e7 ,reports 7#a7 ,in general ,not later than #bgj days after the date of the enactment of this ,act1 and every #ahj days thereafter for three years1 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives a report on the progress of implementation of the online portal required under subsection 7a74 7#b7 ,elements ,each report required under paragraph 7#a7 shall include-- 7,a7 whether a contract with a non-,department entity was procured to carry out subsection 7a7 and1 if so1 information on which entity or entities to which the contract was awarded2 7,b7 the number of applications for medical care under section #agha of title #ch1 ,united ,states ,code1 that are currently pending1 disaggregated by whether they were received-- 7i7 by mail2 7ii7 by fax2 or 7iii7 electronically2 7,c7 a description of efforts taken by the ,department to conduct outreach under subsection 7c72 and 7,d7 an assessment of user satisfaction with the new online portal required under subsection 7a74 #cje4 ,review of workflows associated with processing referrals between facilities of the ,veterans ,health ,administration 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall conduct a review of the workflows directly associated with processing referrals of patients between facilities of the ,veterans ,health ,administration to identify specific delays or bottlenecks in such referrals4 7b7 ,inclusion of consult management review ,the review required under subsection 7a7 shall include-- 7#a7 a review of the interfacility consult management guidance of the ,veterans ,health ,administration that assists facilities in setting up a workflow for consults between facilities2 and 7#b7 a review of the roles and responsibilities of the individuals involved in the consult management process in managing those consults1 including the role of the referral coordination team4 7c7 ,report ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the results of the review conducted under subsection 7a74