USC Subchapter I

in effect

38 U.S.C. § 1701 Definitions

For the purposes of this chapter— (1) The term “disability” means a disease, injury, or other physical or mental defect. (2) The term “veteran of any war” includes any veteran awarded the Medal of Honor. (3) The term “facilities of the Department” means—(A) facilities over which the Secretary has direct jurisdiction; (B) Government facilities for which the Secretary contracts; and (C) public or private facilities at which the Secretary provides recreational activities for patients receiving care under section 1710 of this title. (4) The term “non-Department facilities” means facilities other than Department facilities. (5) The term “hospital care” includes—(A)(i) medical services rendered in the course of the hospitalization of any veteran, and (ii) travel and incidental expenses pursuant to the provisions of section 111 of this title; (B) such mental health services, consultation, professional counseling, marriage and family counseling, and training for the members of the immediate family or legal guardian of a veteran, or the individual in whose household such veteran certifies an intention to live, as the Secretary considers appropriate for the effective treatment and rehabilitation of a veteran or dependent or survivor of a veteran receiving care under the last sentence of section 1781(b) of this title; and (C)(i) medical services rendered in the course of the hospitalization of a dependent or survivor of a veteran receiving care under the last sentence of section 1781(b) of this title, and (ii) travel and incidental expenses for such dependent or survivor under the terms and conditions set forth in section 111 of this title. (6) The term “medical services” includes, in addition to medical examination, treatment, and rehabilitative services, the following:(A) Surgical services. (B) Dental services and appliances as described in sections 1710 and 1712 of this title. (C) Optometric and podiatric services. (D) Preventive health services. (E) Noninstitutional extended care services, including alternatives to institutional extended care that the Secretary may furnish directly, by contract, or through provision of case management by another provider or payer. (F) In the case of a person otherwise receiving care or services under this chapter—(i) wheelchairs, artificial limbs, trusses, and similar appliances; (ii) special clothing made necessary by the wearing of prosthetic appliances; and (iii) such other supplies or services as the Secretary determines to be reasonable and necessary. (G) Travel and incidental expenses pursuant to section 111 of this title. (H) Chiropractic services. (I) The provision of medically necessary van lifts, raised doors, raised roofs, air conditioning, and wheelchair tiedowns for passenger use. (7) The term “domiciliary care” includes necessary medical services and travel and incidental expenses pursuant to the provisions of section 111 of this title. (8) The term “rehabilitative services” means such professional, counseling, chiropractic, and guidance services and treatment programs as are necessary to restore, to the maximum extent possible, the physical, mental, and psychological functioning of an ill or disabled person. (9) The term “preventive health services” means—(A) periodic medical and dental examinations; (B) patient health education (including nutrition education); (C) maintenance of drug use profiles, patient drug monitoring, and drug utilization education; (D) mental health preventive services; (E) substance abuse prevention measures; (F) chiropractic examinations and services; (G) immunizations against infectious diseases, including each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule; (H) prevention of musculoskeletal deformity or other gradually developing disabilities of a metabolic or degenerative nature; (I) genetic counseling concerning inheritance of genetically determined diseases; (J) routine vision testing and eye care services; (K) periodic reexamination of members of likely target populations (high-risk groups) for selected diseases and for functional decline of sensory organs, together with attendant appropriate remedial intervention; and (L) such other health-care services as the Secretary may determine to be necessary to provide effective and economical preventive health care. (10) The term “recommended adult immunization schedule” means the schedule established (and periodically reviewed and, as appropriate, revised) by the Advisory Committee on Immunization Practices established by the Secretary of Health and Human Services and delegated to the Centers for Disease Control and Prevention.

38 U.S.C. § 1702 Presumptions: psychosis after service in World War II and following periods of war; mental illness after service in the Persian Gulf War

(a) Psychosis.—For the purposes of this chapter, any veteran of World War II, the Korean conflict, the Vietnam era, or the Persian Gulf War who developed an active psychosis (1) within two years after discharge or release from the active military, naval, or air service, and (2) before July 26, 1949, in the case of a veteran of World War II, before February 1, 1957, in the case of a veteran of the Korean conflict, before May 8, 1977, in the case of a Vietnam era veteran, or before the end of the two-year period beginning on the last day of the Persian Gulf War, in the case of a veteran of the Persian Gulf War, shall be deemed to have incurred such disability in the active military, naval, or air service. (b) Mental Illness.—For purposes of this chapter, any veteran of the Persian Gulf War who develops an active mental illness (other than psychosis) shall be deemed to have incurred such disability in the active military, naval, or air service if such veteran develops such disability—(1) within two years after discharge or release from the active military, naval, or air service; and (2) before the end of the two-year period beginning on the last day of the Persian Gulf War.

38 U.S.C. § 1703 Veterans Community Care Program

(a) In General.—(1) There is established a program to furnish hospital care, medical services, and extended care services to covered veterans through health care providers specified in subsection (c). (2) The Secretary shall coordinate the furnishing of hospital care, medical services, and extended care services under this section to covered veterans, including coordination of, at a minimum, the following:(A) Ensuring the scheduling of medical appointments in a timely manner and the establishment of a mechanism to receive medical records from non-Department providers. (B) Ensuring continuity of care and services. (C) Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides. (D) Ensuring that covered veterans do not experience a lapse in care resulting from errors or delays by the Department or its contractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services. (3) A covered veteran may only receive care or services under this section upon the authorization of such care or services by the Secretary. (4) Nothing in this section shall be construed to authorize the Secretary to suspend the program established under paragraph (1). (b) Covered Veterans.—For purposes of this section, a covered veteran is any veteran who—(1) is enrolled in the system of annual patient enrollment established and operated under section 1705 of this title; or (2) is not enrolled in such system but is otherwise entitled to hospital care, medical services, or extended care services under subsection (c)(2) of such section. (c) Health Care Providers Specified.—Health care providers specified in this subsection are the following:(1) Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including any physician furnishing services under such a program. (2) The Department of Defense. (3) The Indian Health Service. (4) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))). (5) Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section. (d) Conditions Under Which Care Is Required To Be Furnished Through Non-Department Providers.—(1) The Secretary shall, subject to the availability of appropriations, furnish hospital care, medical services, and extended care services to a covered veteran through health care providers specified in subsection (c) if—(A) the Department does not offer the care or services the veteran requires; (B) the Department does not operate a full-service medical facility in the State in which the covered veteran resides; (C)(i) the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018; (ii) continues to reside in a location that would qualify the veteran for eligibility under such section; and (iii) either—(I) resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or (II) resides in a State not described in subclause (I) and—(aa) received care or services under this title in the year preceding the enactment of the Caring for Our Veterans Act of 2018; and (bb) is seeking care or services within 2 years of the date of the enactment of the Caring for Our Veterans Act of 2018; (D) the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title; or (E) the covered veteran and the covered veteran’s referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best medical interest of the covered veteran based upon criteria developed by the Secretary. (2) The Secretary shall ensure that the criteria developed under paragraph (1)(E) include consideration of the following:(A) The distance between the covered veteran and the facility that provides the hospital care, medical services, or extended care services the veteran needs. (B) The nature of the hospital care, medical services, or extended care services required. (C) The frequency that the hospital care, medical services, or extended care services needs to be furnished. (D) The timeliness of available appointments for the hospital care, medical services, or extended care services the veteran needs. (E) Whether the covered veteran faces an unusual or excessive burden to access hospital care, medical services, or extended care services from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the following:(i) Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that impedes the access of the covered veteran. (ii) Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably accessible to a covered veteran. (iii) Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel. (iv) Whether there is compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facility of the Department. (v) Such other considerations as the Secretary considers appropriate. (3) If the Secretary has determined that the Department does not offer the care or services the covered veteran requires under subparagraph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran resides under subparagraph (B) of such paragraph, that the covered veteran is described under subparagraph (C) of such paragraph, or that the Department is not able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title under subparagraph (D) of such paragraph, the decision to receive hospital care, medical services, or extended care services under such subparagraphs from a health care provider specified in subsection (c) shall be at the election of the veteran. (4) In determining under paragraph (1)(D) whether the Department is able to furnish care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title, for purposes of calculating a wait time for a veteran to schedule an appointment at a medical facility of the Department, the Secretary shall measure from the date of request for the appointment, unless a later date has been agreed to by the veteran in consultation with a health care provider of the Department, to the first next available appointment date relevant to the requested medical service. (e) Conditions Under Which Care Is Authorized To Be Furnished Through Non-Department Providers.—(1)(A) The Secretary may furnish hospital care, medical services, or extended care services through a health care provider specified in subsection (c) to a covered veteran served by a medical service line of the Department that the Secretary has determined is not providing care that complies with the standards for quality the Secretary shall establish under section 1703C. (B) In carrying out subparagraph (A), the Secretary shall—(i) measure timeliness of the medical service line at a facility of the Department when compared with the same medical service line at different Department facilities; and (ii) measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines. (C)(i) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than three medical service lines described in such subparagraph at any one health care facility of the Department. (ii) The Secretary may not concurrently furnish hospital care, medical services, or extended care services under subparagraph (A) with respect to more than 36 medical service lines nationally described in such subparagraph. (2) The Secretary may limit the types of hospital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be available, and the clinical care and services that will be available. (3)(A) Except as provided for in subparagraph (B), the hospital care, medical services, and extended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete. (B) The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in subsection (c) through the completion of an episode of care. (4) The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans affected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accordance with regulations the Secretary shall prescribe. (5) When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran. (f) Review of Decisions.—The review of any decision under subsection (d) or (e) shall be subject to the Department’s clinical appeals process, and such decisions may not be appealed to the Board of Veterans’ Appeals. (g) Tiered Network.—(1) To promote the provision of high-quality and high-value hospital care, medical services, and extended care services under this section, the Secretary may develop a tiered provider network of eligible providers based on criteria established by the Secretary for purposes of this section. (2) In developing a tiered provider network of eligible providers under paragraph (1), the Secretary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in selecting a health care provider specified in subsection (c) for receipt of hospital care, medical services, or extended care services under this section. (h) Contracts To Establish Networks of Health Care Providers.—(1)(A) The Secretary shall enter into consolidated, competitively bid contracts to establish networks of health care providers specified in paragraphs (1) and (5) of subsection (c) for purposes of providing sufficient access to hospital care, medical services, or extended care services under this section. (B) For purposes of subparagraph (A), the requirement to enter into consolidated, competitively bid contracts shall not restrict the authority of the Secretary under other provisions of law when modifying such a contract after entering into the contract. (2)(A) The Secretary shall, to the extent practicable, ensure that covered veterans are able to make their own appointments using advanced technology. (B) To the extent practicable, the Secretary shall be responsible for the scheduling of appointments for hospital care, medical services, and extended care services under this section. (3)(A) The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum—(i) the entity—(I) failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section; (II) failed to comply with the access standards or the standards for quality established by the Secretary; (III) is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); (IV) is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or (V) has been convicted of a felony or other serious offense under Federal or State law and the continued participation of the entity would be detrimental to the best interests of veterans or the Department; (ii) it is reasonable to terminate the contract based on the health care needs of veterans; or (iii) it is reasonable to terminate the contract based on coverage provided by contracts or sharing agreements entered into under authorities other than this section. (B) Nothing in subparagraph (A) may be construed to restrict the authority of the Secretary to terminate a contract entered into under paragraph (1) under any other provision of law. (4) Whenever the Secretary provides notice to an entity that the entity is failing to meet contractual obligations entered into under paragraph (1), 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 such failure. Such report shall include the following:(A) An explanation of the reasons for providing such notice. (B) A description of the effect of such failure, including with respect to cost, schedule, and requirements. (C) A description of the actions taken by the Secretary to mitigate such failure. (D) A description of the actions taken by the contractor to address such failure. (E) A description of any effect on the community provider market for veterans in the affected area. (5)(A) The Secretary shall instruct each entity awarded a contract under paragraph (1) to recognize and accept, on an interim basis, the credentials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Community Care Program and the Veterans Choice Program under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note), as qualified providers under the program established under this section. (B) The interim acceptance period under subparagraph (A) shall be determined by the Secretary based on the following criteria:(i) With respect to a health care provider, when the current certification agreement for the health care provider expires. (ii) Whether the Department has enacted certification and eligibility criteria and regulatory procedures by which non-Department providers will be authorized under this section. (6) The Secretary shall establish a system or systems for monitoring the quality of care provided to covered veterans through a network under this subsection and for assessing the quality of hospital care, medical services, and extended care services furnished through such network before the renewal of the contract for such network. (i) Payment Rates for Care and Services.—(1) Except as provided in paragraph (2), and to the extent practicable, the rate paid for hospital care, medical services, or extended care services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare program under title XI or title XVIII of the Social Security Act (42 U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C. 1395m), for the same care or services. (2)(A) A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area. (B) In this paragraph, the term “highly rural area” means an area located in a county that has fewer than seven individuals residing in that county per square mile. (3) With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract or provider agreement, is in effect. (4) With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, the Medicare payment rates under paragraph (2)(A) shall be calculated based on the payment rates under such agreement. (5) Notwithstanding paragraph (1), the Secretary may incorporate, to the extent practicable, the use of value-based reimbursement models to promote the provision of high-quality care. (6) With respect to hospital care, medical services, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such care or services shall be determined by the Secretary. (j) Treatment of Other Health Plan Contracts.—In any case in which a covered veteran is furnished hospital care, medical services, or extended care services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of this title, the Secretary shall recover or collect reasonable charges for such care or services from a health plan contract described in section 1729 in accordance with such section. (k) Payment by Veteran.—A covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a medical facility of the Department or from a health care provider of the Department. (l) Transplant Authority for Improved Access.—(1) In the case of a covered veteran described in paragraph (2), the Secretary shall determine whether to authorize an organ or bone marrow transplant for that covered veteran at a non-Department facility. (2) A covered veteran described in this paragraph—(A) requires an organ or bone marrow transplant; and (B) has, in the opinion of the primary care provider of the veteran, a medically compelling reason to travel outside the region of the Organ Procurement and Transplantation Network, established under section 372 of the National Organ Transplantation Act 11 See References in Text note below. (Public Law 98–507; 42 U.S.C. 274), in which the veteran resides, to receive such transplant. (m) Monitoring of Care Provided.—(1)(A) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018, and not less frequently than annually thereafter, the Secretary shall submit to appropriate committees of Congress a review of the types and frequency of care sought under subsection (d). (B) The review submitted under subparagraph (A) shall include an assessment of the following:(i) The top 25 percent of types of care and services most frequently provided under subsection (d) due to the Department not offering such care and services. (ii) The frequency such care and services were sought by covered veterans under this section. (iii) An analysis of the reasons the Department was unable to provide such care and services. (iv) Any steps the Department took to provide such care and services at a medical facility of the Department. (v) The cost of such care and services. (2) In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following:(A) With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)—(i) compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service; (ii) identify gaps in hospital care, medical services, or extended care services furnished through such networks; (iii) identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care services are furnished through such networks; (iv) assess the total amounts spent by the Department on hospital care, medical services, and extended care services furnished through such networks; (v) assess the timeliness of the Department in referring hospital care, medical services, and extended care services to such networks; and (vi) assess the timeliness of such networks in—(I) accepting referrals; and (II) scheduling and completing appointments. (B) Report the number of medical service lines the Secretary has determined under subsection (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality established by the Secretary. (C) Assess the use of academic affiliates and centers of excellence of the Department to furnish hospital care, medical services, and extended care services to covered veterans under this section. (D) Assess the hospital care, medical services, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department. (3) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year thereafter, 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 information gathered under paragraph (2). (n) Prohibition on Certain Limitations.—(1) The Secretary shall not limit the types of hospital care, medical services, or extended care services covered veterans may receive under this section if it is in the best medical interest of the veteran to receive such hospital care, medical services, or extended care services, as determined by the veteran and the veteran’s health care provider. (2) No provision in this section may be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services. (o) Outreach Regarding Availability of Care and Services.—(1) The Secretary shall conduct outreach to inform veterans of the following:(A) The conditions for care or services under subsections (d) and (e). (B) How to request such care or services. (C) How to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administration. (2) Upon enrollment of a veteran in the system of annual patient enrollment established and operated under section 1705 of this title, and not less frequently than every two years thereafter, the Secretary shall inform the veteran of information described in paragraph (1). (3) The Secretary shall ensure that information described in paragraph (1) is—(A) publicly displayed in each medical facility of the Department; (B) prominently displayed on a website of the Department; and (C) included in other outreach campaigns and activities conducted by the Secretary. (p) Annual Review and Report on Waivers of Payment Rates.—(1) On an annual basis, the Secretary shall—(A) conduct a review of waivers of payment rates under subsection (i) for Third Party Administrators to identify whether such waivers help to alleviate community-specific challenges, including scarcity of medical services associated with access to health care; and (B) submit to Congress a report on the results of such review. (2) Each report under paragraph (1)(B) shall include, with respect to the period covered by the report—(A) a statement, disaggregated by region, of the total number of waivers described in subparagraph (A) of such paragraph requested by Third Party Administrators; (B) a statement of the total number of such waivers that were—(i) granted by the Secretary; (ii) denied by the Secretary; or (iii) withdrawn by a Third Party Administrator; (C) a description of the process for the review required under paragraph (1); (D) a statement, disaggregated by region, of the average time to process such waivers; (E) an assessment, disaggregated by region, of the extent to which such waivers that were granted by the Secretary improved access to health care for covered veterans; and (F) a description of trends, if any, identified by the Secretary with respect to such waivers. (3) In this subsection, the term “Third Party Administrator” has the meaning given such term in section 1703B of this title. (q) Definitions.—In this section:(1) The term “appropriate committees of Congress” means—(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and (B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives. (2) The term “medical service line” means a clinic within a Department medical center.

38 U.S.C. § 1703A Agreements with eligible entities or providers; certification processes

(a) Agreements Authorized.—(1)(A) When hospital care, a medical service, or an extended care service required by a covered individual who is entitled to such care or service under this chapter is not feasibly available to the covered individual from a facility of the Department or through a contract or sharing agreement entered into pursuant to another provision of law, the Secretary may furnish such care or service to such covered individual through an agreement under this section with an eligible entity or provider to provide such hospital care, medical service, or extended care service. (B) An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a “Veterans Care Agreement”. (C) For purposes of subparagraph (A), hospital care, a medical service, or an extended care service may be considered not feasibly available to a covered individual from a facility of the Department or through a contract or sharing agreement described in such subparagraph when the Secretary determines the covered individual’s medical condition, the travel involved, the nature of the care or services required, or a combination of these factors make the use of a facility of the Department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable. (D) A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary. (2)(A) Subject to subparagraph (B), the Secretary shall review each Veterans Care Agreement of material size, as determined by the Secretary or set forth in paragraph (3), for hospital care, a medical service, or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the Department or by contract or sharing agreement entered into pursuant to another provision of law and, if so, take action to do so. (B)(i) The Secretary shall review each Veterans Care Agreement of material size that has been in effect for at least 6 months within the first 2 years of its taking effect, and not less frequently than once every 4 years thereafter. (ii) If a Veterans Care Agreement has not been in effect for at least 6 months by the date of the review required by subparagraph (A), the agreement shall be reviewed during the next cycle required by subparagraph (A), and such review shall serve as its review within the first 2 years of its taking effect for purposes of clause (i). (3)(A) In fiscal year 2019 and in each fiscal year thereafter, in addition to such other Veterans Care Agreements as the Secretary may determine are of material size, a Veterans Care Agreement for the purchase of extended care services that exceeds $5,000,000 annually shall be considered of material size. (B) From time to time, the Secretary may publish a notice in the Federal Register to adjust the dollar amount specified in subparagraph (A) to account for changes in the cost of health care based upon recognized health care market surveys and other available data. (b) Eligible Entities and Providers.—For purposes of this section, an eligible entity or provider is—(1) any provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)) and any physician or other supplier who has enrolled and entered into a participation agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h)); (2) any provider participating under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.); (3) an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)); (4) a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (29 U.S.C. 796a)); or (5) any entity or provider not described in paragraph (1) or (2) of this subsection that the Secretary determines to be eligible pursuant to the certification process described in subsection (c). (c) Eligible Entity or Provider Certification Process.—The Secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section. Such a process shall, at a minimum—(1) establish deadlines for actions on applications for certification; (2) set forth standards for an approval or denial of certification, duration of certification, revocation of an eligible entity or provider’s certification, and recertification of eligible entities or providers; (3) require the denial of certification if the Secretary determines the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a–7 or 1320a–7a) or is currently identified as an excluded source on the System for Award Management Exclusions list described in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations; (4) establish procedures for screening eligible entities or providers according to the risk of fraud, waste, and abuse that are similar to the standards under section 1866(j)(2)(B) of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 of title 48, Code of Federal Regulations, or successor regulations; and (5) incorporate and apply the restrictions and penalties set forth in chapter 21 of title 41 and treat this section as a procurement program only for purposes of applying such provisions. (d) Rates.—To the extent practicable, the rates paid by the Secretary for hospital care, medical services, and extended care services provided under a Veterans Care Agreement shall be in accordance with the rates paid by the United States under section 1703(i) of this title. (e) Terms of Veterans Care Agreements.—(1) Pursuant to regulations promulgated under subsection (k), the Secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services, the number of employees employed by the entity or provider furnishing such care or services, the amount paid by the Secretary to the provider or entity, or other factors as determined by the Secretary. (2) To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree—(A) to accept payment at the rates established in regulations prescribed under this section; (B) that payment by the Secretary under this section on behalf of a covered individual to a provider of services or care shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguish any liability on the part of the covered individual for the treatment or care provided, and no provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement; (C) to provide only the care and services authorized by the Department under this section and to obtain the prior written consent of the Department to furnish care or services outside the scope of such authorization; (D) to bill the Department in accordance with the methodology outlined in regulations prescribed under this section; (E) to not seek to recover or collect from a health plan contract or third party, as those terms are defined in section 1729 of this title, for any care or service that is furnished or paid for by the Department; (F) to provide medical records to the Department in the time frame and format specified by the Department; and (G) to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation. (f) Discontinuation or Nonrenewal of a Veterans Care Agreement.—(1) An eligible entity or provider may discontinue a Veterans Care Agreement at such time and upon such notice to the Secretary as may be provided in regulations prescribed under this section. (2) The Secretary may discontinue a Veterans Care Agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section, if an official designated by the Secretary—(A) has determined that the eligible entity or provider failed to comply substantially with the provisions of the Veterans Care Agreement, or with the provisions of this section or regulations prescribed under this section; (B) has determined the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a–7 or 1320a–7a) or is identified on the System for Award Management Exclusions list as provided in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations; (C) has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under Federal or State law and determines the eligible entity or provider’s continued participation would be detrimental to the best interests of covered individuals or the Department; or (D) has determined that it is reasonable to terminate the agreement based on the health care needs of a covered individual. (g) Quality of Care.—The Secretary shall establish a system or systems for monitoring the quality of care provided to covered individuals through Veterans Care Agreements and for assessing the quality of hospital care, medical services, and extended care services furnished by eligible entities and providers before the renewal of Veterans Care Agreements. (h) Disputes.—(1) The Secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements. (2) Such procedures constitute the eligible entities’ and providers’ exhaustive and exclusive administrative remedies. (3) Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section 1346 of title 28 (known as the “Tucker Act”). (4) Disputes under this section must pertain to either the scope of authorization under the Veterans Care Agreement or claims for payment subject to the Veterans Care Agreement and are not claims for the purposes of such laws that would otherwise require application of sections 7101 through 7109 of title 41. (i) Applicability of Other Provisions of Law.—(1) A Veterans Care Agreement may be authorized by the Secretary or any Department official authorized by the Secretary, and such action shall not be treated as—(A) an award for the purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of care and services; or (B) a Federal contract for the acquisition of goods or services for purposes of any provision of Federal law governing Federal contracts for the acquisition of goods or services except section 4706(d) of title 41. (2)(A) Except as provided in the agreement itself, in subparagraph (B), and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible entity or provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject. (B) An eligible entity or provider that enters into an agreement under this section is subject to—(i) all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and (ii) all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities. (3) Notwithstanding paragraph (2)(B)(i), an eligible entity or provider that enters into an agreement under this section shall not be treated as a Federal contractor or subcontractor for purposes of chapter 67 of title 41 (commonly known as the “McNamara-O’Hara Service Contract Act of 1965”). (j) Parity of Treatment.—Eligibility for hospital care, medical services, and extended care services furnished to any covered individual pursuant to a Veterans Care Agreement shall be subject to the same terms as though provided in a facility of the Department, and provisions of this chapter applicable to covered individuals receiving such care and services in a facility of the Department shall apply to covered individuals treated under this section. (k) Rulemaking.—The Secretary shall promulgate regulations to carry out this section. (l) Covered Individual Defined.—In this section, the term “covered individual” means any individual eligible for hospital care, medical services, or extended care services under this title or any other law administered by the Secretary.

38 U.S.C. § 1703B Access standards

(a)(1) The Secretary shall establish access standards for furnishing hospital care, medical services, or extended care services to covered veterans for the purposes of section 1703(d). (2) The Secretary shall ensure that the access standards established under paragraph (1) define such categories of care to cover all care and services within the medical benefits package of the Department of Veterans Affairs. (b) The Secretary shall ensure that the access standards provide covered veterans, employees of the Department, and health care providers in the network established under section 1703(h) with relevant comparative information that is clear, useful, and timely, so that covered veterans can make informed decisions regarding their health care. (c) The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services), entities in the private sector, and other nongovernmental entities in establishing access standards. (d)(1) Not later than 270 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report detailing the access standards. (2)(A) Before submitting the report required under paragraph (1), the Secretary shall provide periodic updates to the appropriate committees of Congress to confirm the Department’s progress towards developing the access standards required by this section. (B) The first update under subparagraph (A) shall occur no later than 120 days from the date of the enactment of the Caring for Our Veterans Act of 2018. (3) Not later than 540 days after the date on which the Secretary implements the access standards established under subsection (a), the Secretary shall submit to the appropriate committees of Congress a report detailing the implementation of and compliance with such access standards by Department and non-Department entities or providers. (e) Not later than 3 years after the date on which the Secretary establishes access standards under subsection (a) and not less frequently than once every 3 years thereafter, the Secretary shall—(1) conduct a review of such standards; and (2) submit to the appropriate committees of Congress a report on the findings and any modification to the access standards with respect to the review conducted under paragraph (1). (f)(1) Subject to paragraph (3), the Secretary shall meet the access standards established under subsection (a) when furnishing hospital care, medical services, or extended care services to a covered veteran under section 1703 of this title and shall ensure that meeting such access standards is reflected in the contractual requirements of Third Party Administrators. (2) The Secretary shall ensure that health care providers specified under section 1703(c) of this title are able to comply with the access standards established under subsection (a) for such providers. (3)(A) A Third Party Administrator may request a waiver to the requirement under this subsection to meet the access standards established under subsection (a) if—(i)(I) the scarcity of available providers or facilities in the region precludes the Third Party Administrator from meeting those access standards; or (II) the landscape of providers or facilities has changed, and certain providers or facilities are not available such that the Third Party Administrator is not able to meet those access standards; and (ii) to address the scarcity of available providers or the change in the provider or facility landscape, as the case may be, the Third Party Administrator has contracted with other providers or facilities that may not meet those access standards but are the currently available providers or facilities most accessible to veterans within the region of responsibility of the Third Party Administrator. (B) Any waiver requested by a Third Party Administrator under subparagraph (A) must be requested in writing and submitted to the Office of Integrated Veteran Care of the Department for approval by that office. (C) As part of any waiver request under subparagraph (A), a Third Party Administrator must include conclusive evidence and documentation that the access standards established under subsection (a) cannot be met because of scarcity of available providers or changes to the landscape of providers or facilities. (D) In evaluating a waiver request under subparagraph (A), the Secretary shall consider the following:(i) The number and geographic distribution of eligible health care providers available within the geographic area and specialty referenced in the waiver request. (ii) The prevailing market conditions within the geographic area and specialty referenced in the waiver request, which shall include the number and distribution of health care providers contracting with other health care plans (including commercial plans and the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)) operating in the geographic area and specialty referenced in the waiver request. (iii) Whether the service area is comprised of highly rural, rural, or urban areas or some combination of such areas. (iv) How significantly the waiver request differs from the access standards established under subsection (a). (v) The rates offered to providers in the geographic area covered by the waiver. (E) The Secretary shall not consider inability to contract as a valid sole rationale for granting a waiver under subparagraph (A). (g)(1) The Secretary shall publish in the Federal Register and on a publicly available internet website of the Department the designated access standards established under this section for purposes of section 1703(d)(1)(D) of this title. (2) The Secretary shall publish on a publicly available internet website of the Department the access standards established under subsection (a). (h)(1) Consistent with paragraphs (1)(D) and (3) of section 1703(d), covered veterans may contact the Department at any time to request a determination regarding whether they are eligible to receive care and services from a non-Department entity or provider based on the Department being unable to furnish such care and services in a manner that complies with the designated access standards established under this section. (2) The Secretary shall establish a process to review such requests from covered veterans to determine whether—(A) the requested care is clinically necessary; and (B) the Department is able to provide such care in a manner that complies with designated access standards established under this section. (3) The Secretary shall promptly respond to any such request by a covered veteran. (i) In this section:(1) The term “appropriate committees of Congress” means—(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and (B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives. (2) The term “covered veterans” means veterans described in section 1703(b) of this title. (3) The term “inability to contract”, with respect to a Third Party Administrator, means the inability of the Third Party Administrator to successfully negotiate and establish a community care network contract with a provider or facility. (4) The term “Third Party Administrator” means an entity that manages a provider network and performs administrative services related to such network within the Veterans Community Care Program under section 1703 of this title.

38 U.S.C. § 1703C Standards for quality

(a) In General.—(1) The Secretary shall establish standards for quality regarding hospital care, medical services, and extended care services furnished by the Department pursuant to this title, including through non-Department health care providers pursuant to section 1703 of this title. (2)(A) In establishing standards for quality under paragraph (1), the Secretary shall consider existing health quality measures that are applied to public and privately sponsored health care systems with the purpose of providing covered veterans relevant comparative information to make informed decisions regarding their health care. (B) The Secretary shall ensure that the standards for quality established under paragraph (1) 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 provider. (3) The Secretary shall collect and consider data for purposes of establishing the standards under paragraph (1). Such data collection shall include—(A) after consultation with veterans service organizations and other key stakeholders on survey development or modification of an existing survey, a survey of veterans who have used hospital care, medical services, or extended care services furnished by the Veterans Health Administration during the most recent 2-year period to assess the satisfaction of the veterans with service and quality of care; and (B) datasets that include, at a minimum, elements relating to the following:(i) Timely care. (ii) Effective care. (iii) Safety, including, at a minimum, complications, readmissions, and deaths. (iv) Efficiency. (v) Outcomes relating to patient quality of life. (4) The Secretary shall consult with all pertinent Federal entities (including the Department of Defense, the Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Indian Health Service), entities in the private sector, and other non-governmental entities including Third Party Administrators in establishing standards for quality. (5) When collecting, considering, and applying data related to patient care for purposes of establishing standards for quality under paragraph (1), the Secretary shall ensure no metric is being over or under analyzed. (6) In establishing standards for quality under paragraph (1), the Secretary shall—(A) utilize the most up-to-date practices for extracting and analyzing relevant data; (B) utilize all relevant data available to the Secretary; (C) ensure the most efficient use of time and resources related to the use of data scientists employed by the Department; and (D) collaborate, as appropriate, with entities specified in paragraph (4). (7)(A) Not less frequently than once every five years, the Secretary shall update the standards for quality established under paragraph (1) pursuant to the requirements for the establishment of such standards under this subsection. (B) Not later than 30 days after any date on which the Secretary updates, pursuant to subparagraph (A), the standards for quality under paragraph (1), the Secretary shall submit to the appropriate committees of Congress a report on such updated standards for quality. (b) Publication and Consideration of Public Comments.—(1) Not less frequently than once every three years, the Secretary shall publish the quality rating of medical facilities of the Department pursuant to standards for quality under subsection (a) in the publicly available Hospital Compare website through the Centers for Medicare & Medicaid Services for the purpose of providing veterans with information that allows them to compare performance measure information among Department and non-Department health care providers. (2) Not later than 2 years after the date on which the Secretary establishes or updates standards for quality under subsection (a), the Secretary shall consider and solicit public comment on potential changes to the measures used in such standards to ensure that they include the most up-to-date and applicable industry measures for veterans. (c) Definitions.— In this section:(1) The term “appropriate committees of Congress” means—(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and (B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives. (2) The term “covered veterans” means veterans described in section 1703(b) of this title.

38 U.S.C. § 1703D Prompt payment standard

(a) In General.—(1) Notwithstanding any other provision of this title or of any other provision of law, the Secretary shall pay for hospital care, medical services, or extended care services furnished by health care entities or providers under this chapter within 45 calendar days upon receipt of a clean paper claim or 30 calendar days upon receipt of a clean electronic claim. (2) If a claim is denied, the Secretary shall, within 45 calendar days of denial for a paper claim and 30 calendar days of denial for an electronic claim, notify the health care entity or provider of the reason for denying the claim and what, if any, additional information is required to process the claim. (3) Upon the receipt of the additional information, the Secretary shall ensure that the claim is paid, denied, or otherwise adjudicated within 30 calendar days from the receipt of the requested information. (4) This section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers. (b) Submittal of Claims by Health Care Entities and Providers.—A health care entity or provider that furnishes hospital care, a medical service, or an extended care service under this chapter shall submit to the Secretary a claim for payment for furnishing the hospital care, medical service, or extended care service not later than 180 days after the date on which the entity or provider furnished the hospital care, medical service, or extended care service. (c) Fraudulent Claims.—(1) Sections 3729 through 3733 of title 31 shall apply to fraudulent claims for payment submitted to the Secretary by a health care entity or provider under this chapter. (2) Pursuant to regulations prescribed by the Secretary, the Secretary shall bar a health care entity or provider from furnishing hospital care, medical services, and extended care services under this chapter when the Secretary determines the entity or provider has submitted to the Secretary fraudulent health care claims for payment by the Secretary. (d) Overdue Claims.—(1) Any claim that has not been denied with notice, made pending with notice, or paid to the health care entity or provider by the Secretary shall be overdue if the notice or payment is not received by the entity provider within the time periods specified in subsection (a). (2)(A) If a claim is overdue under this subsection, the Secretary may, under the requirements established by subsection (a) and consistent with the provisions of chapter 39 of title 31 (commonly referred to as the “Prompt Payment Act”), require that interest be paid on clean claims. (B) Interest paid under subparagraph (A) shall be computed at the rate of interest established by the Secretary of the Treasury under section 3902 of title 31 and published in the Federal Register. (3) Not less frequently than annually, the Secretary shall submit to Congress a report on payment of overdue claims under this subsection, disaggregated by paper and electronic claims, that includes the following:(A) The amount paid in overdue claims described in this subsection, disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim. (B) The number of such overdue claims and the average number of days late each claim was paid, disaggregated by facility of the Department and Veterans Integrated Service Network region. (e) Overpayment.—(1) The Secretary may deduct the amount of any overpayment from payments due a health care entity or provider under this chapter and may use any other means authorized by another provision of law to correct or recover overpayments. (2) Deductions may not be made under this subsection unless the Secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness. (3) The Secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the Secretary’s ability to recover the full amount of such indebtedness. (f) Information and Documentation Required.—(1) The Secretary shall provide to all health care entities and providers participating in a program to furnish hospital care, medical services, or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section. (2) The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1). (3) If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care entities and providers described in paragraph (1) not later than 30 days before such modifications take effect. (g) Processing of Claims.—(1) In processing a claim for compensation for hospital care, medical services, or extended care services furnished by a non-Department health care entity or provider under this chapter, the Secretary may act through—(A) a non-Department entity that is under contract or agreement for the program established under section 1703(a) of this title; or (B) a non-Department entity that specializes in such processing for other Federal agency health care systems. (2) The Secretary shall seek to contract with a third party to conduct a review of claims described in paragraph (3) that includes—(A) a feasibility assessment to determine the capacity of the Department to process such claims in a timely manner; and (B) a cost benefit analysis comparing the capacity of the Department to a third party entity capable of processing such claims. (3) The review required under paragraph (2) shall apply to claims for hospital care, medical services, or extended care services furnished under section 1703 of this title that are processed by the Department. (h) Report on Encounter Data System.—(1) Not later than 90 days after the date of the enactment of the Caring for Our Veterans Act of 2018, the Secretary shall submit to the appropriate committees of Congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other Federal agencies to allow a contracted entity to act as a fiscal intermediary for the Federal Government to distribute, or pass through, Federal Government funds for certain non-underwritten hospital care, medical services, or extended care services. (2) The Secretary may coordinate with the Department of Defense, the Department of Health and Human Services, and the Department of the Treasury in developing the report required by paragraph (1). (i) Definitions.—In this section:(1) The term “appropriate committees of Congress” means—(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and (B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives. (2) The term “clean electronic claim” means the transmission of data for purposes of payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services. (3) The term “clean paper claim” means a paper claim for payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services. (4) The term “fraudulent claims” means the knowing misrepresentation of a material fact or facts by a health care entity or provider made to induce the Secretary to pay a claim that was not legally payable to that provider. (5) The term “health care entity or provider” includes any non-Department health care entity or provider, but does not include any Federal health care entity or provider.

38 U.S.C. § 1703E Center for Innovation for Care and Payment

(a) In General.—(1) There is established within the Department a Center for Innovation for Care and Payment (in this section referred to as the “Center”). (2) The Secretary, acting through the Center, may carry out such pilot programs the Secretary determines to be appropriate to develop innovative approaches to testing payment and service delivery models in order to reduce expenditures while preserving or enhancing the quality of care furnished by the Department. (3) The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models—(A) improve access to, and quality, timeliness, and patient satisfaction of care and services; and (B) create cost savings for the Department. (4)(A) The Secretary shall test a model in a location where the Secretary determines that the model will addresses 11 So in original. deficits in care (including poor clinical outcomes or potentially avoidable expenditures) for a defined population. (B) The Secretary shall focus on models the Secretary expects to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter. (C) The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)). (5) In selecting a model for testing, the Secretary may consider, in addition to other factors identified in this subsection, the following factors:(A) Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of individuals receiving benefits under this chapter. (B) Whether the model places the individual receiving benefits under this chapter (including family members and other caregivers of such individual) at the center of the care team of such individual. (C) Whether the model uses technology or new systems to coordinate care over time and across settings. (D) Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models. (6)(A) Models tested under this section may not be designed in such a way that would allow the United States to recover or collect reasonable charges from a Federal health care program for care or services furnished by the Secretary to a veteran under pilot programs carried out under this section. (B) In this paragraph, the term “Federal health care program” means—(i) an insurance program described in section 1811 of the Social Security Act (42 U.S.C. 1395c) or established by section 1831 of such Act (42 U.S.C. 1395j); (ii) a State plan for medical assistance approved under title XIX of such Act (42 U.S.C. 1396 et seq.); or (iii) a TRICARE program operated under sections 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10. (b) Duration.—Each pilot program carried out by the Secretary under this section shall terminate no later than 5 years after the date of the commencement of the pilot program. (c) Location.—The Secretary shall ensure that each pilot program carried out under this section occurs in an area or areas appropriate for the intended purposes of the pilot program. To the extent practicable, the Secretary shall ensure that the pilot programs are located in geographically diverse areas of the United States. (d) Budget.—Funding for each pilot program carried out by the Secretary under this section shall come from appropriations—(1) provided in advance in appropriations acts for the Veterans Health Administration; and (2) provided for information technology systems. (e) Notice.—The Secretary shall—(1) publish information about each pilot program under this section in the Federal Register; and (2) take reasonable actions to provide direct notice to veterans eligible to participate in such pilot programs. (f) Waiver of Authorities.—(1) Subject to reporting under paragraph (2) and approval under paragraph (3), in implementing a pilot program under this section, the Secretary may waive such requirements in subchapters I, II, and III of this chapter as the Secretary determines necessary solely for the purposes of carrying out this section with respect to testing models described in subsection (a). (2) Before waiving any authority under paragraph (1), the Secretary shall submit to the Speaker of the House of Representatives, the minority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the Senate, and each standing committee with jurisdiction under the rules of the Senate and of the House of Representatives to report a bill to amend the provision or provisions of law that would be waived by the Department, a report on a request for waiver that describes in detail the following:(A) The specific authorities to be waived under the pilot program. (B) The standard or standards to be used in the pilot program in lieu of the waived authorities. (C) The reasons for such waiver or waivers. (D) A description of the metric or metrics the Secretary will use to determine the effect of the waiver or waivers upon the access to and quality, timeliness, or patient satisfaction of care and services furnished through the pilot program. (E) The anticipated cost savings, if any, of the pilot program. (F) The schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program. (G) The schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent. (H) The estimated budget of the pilot program. (3)(A) Upon receipt of a report submitted under paragraph (2), each House of Congress shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the House of Representatives or the Senate to report a bill to amend the provision or provisions of law that would be waived by the Department under this subsection. (B) The waiver requested by the Secretary under paragraph (2) shall be considered approved under this paragraph if there is enacted into law a joint resolution approving such request in its entirety. (C) For purposes of this paragraph, the term “joint resolution” means only a joint resolution which is introduced within the period of five legislative days beginning on the date on which the Secretary transmits the report to the Congress under such paragraph (2), and—(i) which does not have a preamble; and (ii) the matter after the resolving clause of which is as follows: “that Congress approves the request for a waiver under section 1703E(f) of title 38, United States Code, as submitted by the Secretary on __________”, the blank space being filled with the appropriate date. (D)(i) Any committee of the House of Representatives to which a joint resolution is referred shall report it to the House without amendment not later than 15 legislative days after the date of introduction thereof. If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution. (ii) It shall be in order at any time after the third legislative day after each committee authorized to consider a joint resolution has reported or has been discharged from consideration of a joint resolution, to move to proceed to consider the joint resolution in the House. All points of order against the motion are waived. Such a motion shall not be in order after the House has disposed of a motion to proceed on a joint resolution addressing a particular submission. The previous question shall be considered as ordered on the motion to its adoption without intervening motion. The motion shall not be debatable. A motion to reconsider the vote by which the motion is disposed of shall not be in order. (iii) The joint resolution shall be considered as read. All points of order against the joint resolution and against its consideration are waived. The previous question shall be considered as ordered on the joint resolution to its passage without intervening motion except two hours of debate equally divided and controlled by the proponent and an opponent. A motion to reconsider the vote on passage of the joint resolution shall not be in order. (E)(i) A joint resolution introduced in the Senate shall be referred to the Committee on Veterans’ Affairs. (ii) Any committee of the Senate to which a joint resolution is referred shall report it to the Senate without amendment not later than 15 session days after the date of introduction of a joint resolution described in paragraph (C). If a committee fails to report the joint resolution within that period, the committee shall be discharged from further consideration of the joint resolution and the joint resolution shall be placed on the calendar. (iii)(I) Notwithstanding Rule XXII of the Standing Rules of the Senate, it is in order at any time after the third session day on which the Committee on Veterans’ Affairs has reported or has been discharged from consideration of a joint resolution described in paragraph (C) (even though a previous motion to the same effect has been disagreed to) to move to proceed to the consideration of the joint resolution, and all points of order against the joint resolution (and against consideration of the joint resolution) are waived. The motion to proceed is not debatable. The motion is not subject to a motion to postpone. A motion to reconsider the vote by which the motion is agreed to or disagreed to shall not be in order. If a motion to proceed to the consideration of the resolution is agreed to, the joint resolution shall remain the unfinished business until disposed of. (II) Consideration of the joint resolution, and on all debatable motions and appeals in connection therewith, shall be limited to not more than two hours, which shall be divided equally between the majority and minority leaders or their designees. A motion further to limit debate is in order and not debatable. An amendment to, or a motion to postpone, or a motion to proceed to the consideration of other business, or a motion to recommit the joint resolution is not in order. (III) If the Senate has voted to proceed to a joint resolution, the vote on passage of the joint resolution shall occur immediately following the conclusion of consideration of the joint resolution, and a single quorum call at the conclusion of the debate if requested in accordance with the rules of the Senate. (IV) Appeals from the decisions of the Chair relating to the application of the rules of the Senate, as the case may be, to the procedure relating to a joint resolution shall be decided without debate. (F) A joint resolution considered pursuant to this paragraph shall not be subject to amendment in either the House of Representatives or the Senate. (G)(i) If, before the passage by one House of the joint resolution of that House, that House receives the joint resolution from the other House, then the following procedures shall apply:(I) The joint resolution of the other House shall not be referred to a committee. (II) With respect to the joint resolution of the House receiving the joint resolution—(aa) the procedure in that House shall be the same as if no joint resolution had been received from the other House; but (bb) the vote on passage shall be on the joint resolution of the other House. (ii) If the Senate fails to introduce or consider a joint resolution under this paragraph, the joint resolution of the House shall be entitled to expedited floor procedures under this subparagraph. (iii) If, following passage of the joint resolution in the Senate, the Senate then receives the companion measure from the House of Representatives, the companion measure shall not be debatable. (H) This subparagraph is enacted by Congress—(i) as an exercise of the rulemaking power of the Senate and House of Representatives, respectively, and as such it is deemed a part of the rules of each House, respectively, but applicable only with respect to the procedure to be followed in that House in the case of a joint resolution, and it supersedes other rules only to the extent that it is inconsistent with such rules; and (ii) with full recognition of the constitutional right of either House to change the rules (so far as relating to the procedure of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House. (g) Limitations.—(1) The Secretary may not carry out more than 10 pilot programs concurrently. (2)(A) Subject to subparagraph (B), the Secretary may not expend more than $50,000,000 in any fiscal year from amounts under subsection (d). (B) The Secretary may expend more than the amount in subparagraph (A) if—(i) the Secretary determines that the additional expenditure is necessary to carry out pilot programs under this section; (ii) the Secretary submits to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a report setting forth the amount of the additional expenditure and a justification for the additional expenditure; and (iii) the Chairmen of the Committees on Veterans’ Affairs of the Senate and the House of Representatives transmit to the Secretary a letter approving of the additional expenditure. (3) The waiver provisions in subsection (f) shall not apply unless the Secretary, in accordance with the requirements in subsection (f), submits the first proposal for a pilot program not later than 18 months after the date of the enactment of the Caring for Our Veterans Act of 2018. (4) Notwithstanding section 502 of this title, decisions by the Secretary under this section shall, consistent with section 511 of this title, be final and conclusive and may not be reviewed by any other official or by any court, whether by an action in the nature of mandamus or otherwise. (5)(A) If the Secretary determines that a pilot program is not improving the quality of care or producing cost savings, the Secretary shall—(i) propose a modification to the pilot program in the interim report that shall also be considered a report under subsection (f)(2) and shall be subject to the terms and conditions of subsection (f)(2); or (ii) terminate such pilot program not later than 30 days after submitting the interim report to Congress. (B) If the Secretary terminates a pilot program under subparagraph (A)(ii), for purposes of subparagraphs (F) and (G) of subsection (f)(2), such interim report will also serve as the final report for that pilot program. (h) Evaluation and Reporting Requirements.—(1) The Secretary shall conduct an evaluation of each model tested, which shall include, at a minimum, an analysis of—(A) the quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary; and (B) the changes in spending by reason of that model. (2) The Secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the Secretary determines is necessary to monitor and evaluate such models. (i) Coordination and Advice.—(1) The Secretary shall obtain advice from the Under Secretary for Health and the Special Medical Advisory Group established pursuant to section 7312 of this title in the development and implementation of any pilot program operated under this section. (2) In carrying out the duties under this section, the Secretary shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The Secretary shall use appropriate mechanisms to seek input from interested parties. (j) Expansion of Successful Pilot Programs.—Taking into account the evaluation under subsection (f), the Secretary may, through rulemaking, expand (including implementation on a nationwide basis) the duration and the scope of a model that is being tested under subsection (a) to the extent determined appropriate by the Secretary, if—(1) the Secretary determines that such expansion is expected to—(A) reduce spending without reducing the quality of care; or (B) improve the quality of patient care without increasing spending; and (2) the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for individuals receiving benefits under this chapter.

38 U.S.C. § 1703F Credentialing verification requirements for providers of non-Department health care services

(a) In General.—The Secretary shall ensure that Third Party Administrators and credentials verification organizations comply with the requirements specified in subsection (b) to help ensure certain health care providers are excluded from providing non-Department health care services. (b) Requirements Specified.—The Secretary shall require Third Party Administrators and credentials verification organizations to carry out the following:(1) Hold and maintain an active credential verification accreditation from a national health care accreditation body. (2) Conduct initial verification of provider history and license sanctions for all States and United States territories for a period of time—(A) that includes the period before the provider began providing non-Department health care services; and (B) dating back not less than 10 years. (3) Not less frequently than every three years, perform recredentialing, including verifying provider history and license sanctions for all States and United States territories. (4) Implement continuous monitoring of each provider through the National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.). (5) Perform other forms of credentialing verification as the Secretary considers appropriate. (c) Definitions.—In this section:(1) The term “credentials verification organization” means an entity that manages the provider credentialing process and performs credentialing verification for non-Department providers that participate in the Veterans Community Care Program under section 1703 of this title through a Veterans Care Agreement. (2) The term “Third Party Administrator” means an entity that manages a provider network and performs administrative services related to such network within the Veterans Community Care Program under section 1703 of this title. (3) The term “Veterans Care Agreement” means an agreement for non-Department health care services entered into under section 1703A of this title. (4) The term “non-Department health care services” means services—(A) provided under this subchapter at non-Department facilities (as defined in section 1701 of this title); (B) provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note); (C) purchased through the Medical Community Care account of the Department; or (D) purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note).

38 U.S.C. § 1703G Quarterly report on referrals for non-Department health care

The Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Representatives a quarterly report containing, with respect to referrals for non-Department health care originating from a medical facility of the Department during the quarter preceding the date of the submission of the report, a measurement of, for each such medical facility— (1) the period of time between—(A) the date on which a clinician employed by the Department determines that a veteran requires care, or a veteran presents to the Department requesting care, and the date on which the referral for care is sent to a non-Department health care provider; (B) the date on which such referral is sent to a non-Department health care provider and the date on which such non-Department health care provider accepts such referral; (C) the date on which such non-Department health care provider accepts such referral and the date on which such referral is completed; (D) the date on which such referral is completed and the date on which an appointment with a non-Department health care provider is made; and (E) the date on which such an appointment is made and the date on which such appointment occurs; and (2) any other period of time that the Secretary determines necessary.

38 U.S.C. § 1704 Preventive health services: annual report

Not later than October 31 each year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on preventive health services. Each such report shall include the following: (1) A description of the programs and activities of the Department with respect to preventive health services during the preceding fiscal year, including a description of the following:(A) The programs conducted by the Department—(i) to educate veterans with respect to health promotion and disease prevention; (ii) to provide veterans with preventive health screenings and other clinical services, with such description setting forth the types of resources used by the Department to conduct such screenings and services and the number of veterans reached by such screenings and services; and (iii) to provide veterans each immunization on the recommended adult immunization schedule at the time such immunization is indicated on that schedule. (B) The means by which the Secretary addressed the specific preventive health services needs of particular groups of veterans (including veterans with service-connected disabilities, elderly veterans, low-income veterans, women veterans, institutionalized veterans, and veterans who are at risk for mental illness). (C) The manner in which the provision of such services was coordinated with the activities of the Medical and Prosthetic Research Service of the Department and the National Center for Preventive Health. (D) The manner in which the provision of such services was integrated into training programs of the Department, including initial and continuing medical training of medical students, residents, and Department staff. (E) The manner in which the Department participated in cooperative preventive health efforts with other governmental and private entities (including State and local health promotion offices and not-for-profit organizations). (F) The specific research carried out by the Department with respect to the long-term relationships among screening activities, treatment, and morbidity and mortality outcomes. (G) The cost effectiveness of such programs and activities, including an explanation of the means by which the costs and benefits (including the quality of life of veterans who participate in such programs and activities) of such programs and activities are measured. (2) A specific description of research activities on preventive health services carried out during that period using employees, funds, equipment, office space, or other support services of the Department, with such description setting forth—(A) the source of funds for those activities; (B) the articles or publications (including the authors of the articles and publications) in which those activities are described; (C) the Federal, State, or local governmental entity or private entity, if any, with which such activities were carried out; and (D) the clinical, research, or staff education projects for which funding applications were submitted (including the source of the funds applied for) and upon which a decision is pending or was denied. (3) An accounting of the expenditure of funds during that period by the National Center for Preventive Health under section 7318 of this title.

38 U.S.C. § 1704A Independent assessments of health care delivery systems and management processes

(a) Independent Assessments.—(1) Not less frequently than once every 10 years, the Secretary shall enter into one or more contracts with a private sector entity or entities described in subsection (d) to conduct an independent assessment of the hospital care, medical services, and other health care furnished by the Department. (2) Each assessment required under paragraph (1) shall address each of the following:(A) Current and projected demographics and unique health care needs of the patient population served by the Department. (B) The accuracy of models and forecasting methods used by the Department to project health care demand, including with respect to veteran demographics, rates of use of health care furnished by the Department, the inflation of health care costs, and such other factors as may be determined relevant by the Secretary. (C) The reliability and accuracy of models and forecasting methods used by the Department to project the budgetary needs of the Veterans Health Administration and how such models and forecasting methods inform budgetary trends. (D) The authorities and mechanisms under which the Secretary may furnish hospital care, medical services, and other health care at facilities of the Department and non-Department facilities, including through Federal and private sector partners and at joint medical facilities, and the effect of such authorities and mechanisms on eligibility and access to care. (E) The organization, workflow processes, and tools used by the Department to support clinical staffing, access to care, effective length-of-stay management and care transitions, positive patient experience, accurate documentation, and subsequent coding of inpatient services. (F) The efforts of the Department to recruit and retain staff at levels necessary to carry out the functions of the Veterans Health Administration and the process used by the Department to determine staffing levels necessary for such functions. (G) The staffing level at each medical facility of the Department and the productivity of each health care provider at the medical facility, compared with health care industry performance metrics, which may include the following:(i) An assessment of the case load of, and number of patients treated by, each health care provider at such medical facility during an average week. (ii) An assessment of the time spent by each such health care provider on matters other than the case load of the health care provider, including time spent by the health care provider as follows:(I) At a medical facility that is affiliated with the Department. (II) Conducting research. (III) Training or supervising other health care professionals of the Department. (iii) An assessment of the complexity of health care conditions per patient treated by each health care provider at such medical facility during an average week. (H) The information technology strategies of the Department with respect to furnishing and managing health care, including an identification of any weaknesses or opportunities with respect to the technology used by the Department, especially those strategies with respect to clinical documentation of hospital care, medical services, and other health care, including any clinical images and associated textual reports, furnished by the Department in facilities of the Department or non-Department facilities. (I) Business processes of the Veterans Health Administration, including processes relating to furnishing non-Department health care, insurance identification, third-party revenue collection, and vendor reimbursement, including an identification of mechanisms as follows:(i) To avoid the payment of penalties to vendors. (ii) To increase the collection of amounts owed to the Department for hospital care, medical services, or other health care provided by the Department for which reimbursement from a third party is authorized and to ensure that such amounts collected are accurate. (iii) To increase the collection of any other amounts owed to the Department with respect to hospital care, medical services, or other health care and to ensure that such amounts collected are accurate. (iv) To increase the accuracy and timeliness of payments by the Department to vendors and providers. (v) To reduce expenditures while improving the quality of care furnished. (J) The purchase, distribution, and use of pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services by the Department, including the following:(i) The prices paid for, standardization of, and use by, the Department with respect to the following:(I) Pharmaceuticals. (II) Medical and surgical supplies. (III) Medical devices. (ii) The use by the Department of group purchasing arrangements to purchase pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services. (iii) The strategy and systems used by the Department to distribute pharmaceuticals, medical and surgical supplies, medical devices, and health care-related services to Veterans Integrated Service Networks and medical facilities of the Department. (K) The competency of Department leadership with respect to culture, accountability, reform readiness, leadership development, physician alignment, employee engagement, succession planning, and performance management. (L) The effectiveness of the authorities and programs of the Department to educate and train health personnel pursuant to section 7302 of this title. (M) The conduct of medical and prosthetic research of the Department. (N) The provision of assistance by the Department to Federal agencies and personnel involved in responding to a disaster or emergency. (O) Such additional matters as may be determined relevant by the Secretary. (b) Timing.—The private sector entity or entities carrying out an assessment pursuant to subsection (a) shall complete such assessment not later than 18 months after entering into the contract described in such paragraph. (c) Leveraging of Existing Data and Contracts.—To the extent practicable, the private sector entity or entities carrying out an assessment pursuant to subsection (a) shall—(1) make maximum use of existing data that has been compiled by the Department, compiled for the Department, or purchased by the Department, including data that has been collected for—(A) the performance of quadrennial market assessments under section 7330C of this title; (B) the quarterly publication of information on staffing and vacancies with respect to the Veterans Health Administration pursuant to section 505 of the VA MISSION Act of 2018 (Public Law 115–182; 38 U.S.C. 301 note); and (C) the conduct of annual audits pursuant to section 3102 of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (Public Law 116–315; 38 U.S.C. 1701 note). (2) maximize the use of existing contracts and other agreements of the Department for studies, analysis, data collection, or research in order to efficiently fulfill the requirements of this section. (d) Private Sector Entities Described.—A private sector entity described in this subsection is a private entity that—(1) has experience and proven outcomes in optimizing the performance of national health care delivery systems, including the Veterans Health Administration, other federal health care systems, and systems in the private, non-profit, or public health care sector; (2) specializes in implementing large-scale organizational and cultural transformations, especially with respect to health care delivery systems; and (3) is not currently under contract with the Department to provide direct or indirect patient care or related clinical care services or supplies under the laws administered by the Secretary. (e) Program Integrator.—(1) If the Secretary enters into contracts with more than one private sector entity under subsection (a) with respect to a single assessment under such subsection, the Secretary shall designate one such entity as the program integrator. (2) The program integrator designated pursuant to paragraph (1) shall be responsible for coordinating the outcomes of the assessments conducted by the private sector entities pursuant to such contracts. (f) Reports.—(1)(A) Not later than 60 days after completing an assessment pursuant to subsection (a), the private sector entity or entities carrying out such assessment shall submit to the Secretary and the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the findings and recommendations of the private sector entity or entities with respect to such assessment. (B) Each report under subparagraph (A) with respect to an assessment shall include an identification of the following:(i) Any changes with respect to the matters included in such assessment since the date that is the later of the following:(I) The date on which the independent assessment under section 201 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) was completed. (II) The date on which the last assessment under subsection (a) was completed. (ii) Any recommendations regarding matters to be covered by subsequent assessments under subsection (a), including any additional matters to include for assessment or previously assessed matters to exclude. (2) Not later than 30 days after receiving a report under paragraph (1), the Secretary shall publish such report in the Federal Register and on a publicly accessible internet website of the Department. (3) Not later than 90 days after receiving a report under paragraph (1), 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 outlining the feasibility and advisability of implementing the recommendations made by the private sector entity or entities in such report received, including an identification of the timeline, cost, and any legislative authorities necessary for such implementation. (g) Sunset.—The requirement to enter into contracts under subsection (a) shall terminate on December 31, 2055.

38 U.S.C. § 1705 Management of health care: patient enrollment system

(a) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary, in accordance with regulations the Secretary shall prescribe, shall establish and operate a system of annual patient enrollment. The Secretary shall manage the enrollment of veterans in accordance with the following priorities, in the order listed:(1) Veterans with service-connected disabilities rated 50 percent or greater and veterans who were awarded the medal of honor under section 7271, 8291, or 9271 of title 10 or section 491 11 See References in Text note below. of title 14. (2) Veterans with service-connected disabilities rated 30 percent or 40 percent. (3) Veterans who are former prisoners of war or who were awarded the Purple Heart, veterans with service-connected disabilities rated 10 percent or 20 percent, and veterans described in subparagraphs (B) and (C) of section 1710(a)(2) of this title. (4) Veterans who are in receipt of increased pension based on a need of regular aid and attendance or by reason of being permanently housebound and other veterans who are catastrophically disabled. (5) Veterans not covered by paragraphs (1) through (4) who are unable to defray the expenses of necessary care as determined under section 1722(a) of this title. (6) All other veterans eligible for hospital care, medical services, and nursing home care under section 1710(a)(2) of this title. (7) Veterans described in section 1710(a)(3) of this title who are eligible for treatment as a low-income family under section 3(b) of the United States Housing Act of 1937 (42 U.S.C. 1437a(b)) for the area in which such veterans reside, regardless of whether such veterans are treated as single person families under paragraph (3)(A) of such section 3(b) or as families under paragraph (3)(B) of such section 3(b). (8) Veterans described in section 1710(a)(3) of this title who are not covered by paragraph (7). (b) In the design of an enrollment system under subsection (a), the Secretary—(1) shall ensure that the system will be managed in a manner to ensure that the provision of care to enrollees is timely and acceptable in quality; (2) may establish additional priorities within each priority group specified in subsection (a), as the Secretary determines necessary; and (3) may provide for exceptions to the specified priorities where dictated by compelling medical reasons. (c)(1) The Secretary may not provide hospital care or medical services to a veteran under paragraph (2) or (3) of section 1710(a) of this title unless the veteran enrolls in the system of patient enrollment established by the Secretary under subsection (a). (2) The Secretary shall provide hospital care and medical services under section 1710(a)(1) of this title, and under subparagraph (B) of section 1710(a)(2) of this title, for the 12-month period following such veteran’s discharge or release from service, to any veteran referred to in such sections for a disability specified in the applicable subparagraph of such section, notwithstanding the failure of the veteran to enroll in the system of patient enrollment referred to in subsection (a) of this section.

38 U.S.C. § 1705A Management of health care: information regarding health-plan contracts

(a) In General.—(1) Any individual who seeks hospital care or medical services under this chapter shall provide to the Secretary such current information as the Secretary may require to identify any health-plan contract under which such individual is covered. (2) The information required to be provided to the Secretary under paragraph (1) with respect to a health-plan contract shall include, as applicable, the following:(A) The name of the entity providing coverage under the health-plan contract. (B) If coverage under the health-plan contract is in the name of an individual other than the individual required to provide information under this section, the name of the policy holder of the health-plan contract. (C) The identification number for the health-plan contract. (D) The group code for the health-plan contract. (b) Action To Collect Information.—The Secretary may take such action as the Secretary considers appropriate to collect the information required under subsection (a). (c) Effect on Services From Department.—The Secretary may not deny any services under this chapter to an individual solely due to the fact that the individual fails to provide information required under subsection (a). (d) Health-Plan Contract Defined.—In this section, the term “health-plan contract” has the meaning given that term in section 1725(h) of this title.

38 U.S.C. § 1706 Management of health care: other requirements

(a) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary shall, to the extent feasible, design, establish and manage health care programs in such a manner as to promote cost-effective delivery of health care services in the most clinically appropriate setting. (b)(1) In managing the provision of hospital care and medical services under such section, the Secretary shall ensure that the Department (and each geographic service area of the Veterans Health Administration) maintains its capacity to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, blindness, amputations, and mental illness) within distinct programs or facilities of the Department that are dedicated to the specialized needs of those veterans in a manner that (A) affords those veterans reasonable access to care and services for those specialized needs, and (B) ensures that overall capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide such services is not reduced below the capacity of the Department, nationwide, to provide those services, as of October 9, 1996. The Secretary shall carry out this paragraph in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Committee on Care of Severely Chronically Mentally Ill Veterans. (2) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans (including veterans with spinal cord dysfunction, traumatic brain injury, blindness, prosthetics and sensory aids, and mental illness) within distinct programs or facilities shall be measured for seriously mentally ill veterans as follows (with all such data to be provided by geographic service area and totaled nationally):(A) For mental health intensive community-based care, the number of discrete intensive care teams constituted to provide such intensive services to seriously mentally ill veterans and the number of veterans provided such care. (B) For opioid substitution programs, the number of patients treated annually and the amounts expended. (C) For dual-diagnosis patients, the number treated annually and the amounts expended. (D) For substance-use disorder programs—(i) the number of beds (whether hospital, nursing home, or other designated beds) employed and the average bed occupancy of such beds; (ii) the percentage of unique patients admitted directly to outpatient care during the fiscal year who had two or more additional visits to specialized outpatient care within 30 days of their first visit, with a comparison from 1996 until the date of the report; (iii) the percentage of unique inpatients with substance-use disorder diagnoses treated during the fiscal year who had one or more specialized clinic visits within three days of their index discharge, with a comparison from 1996 until the date of the report; (iv) the percentage of unique outpatients seen in a facility or geographic service area during the fiscal year who had one or more specialized clinic visits, with a comparison from 1996 until the date of the report; and (v) the rate of recidivism of patients at each specialized clinic in each geographic service area of the Veterans Health Administration. (E) For mental health programs, the number and type of staff that are available at each facility to provide specialized mental health treatment, including satellite clinics, outpatient programs, and community-based outpatient clinics, with a comparison from 1996 to the date of the report. (F) The number of such clinics providing mental health care, the number and type of mental health staff at each such clinic, and the type of mental health programs at each such clinic. (G) The total amounts expended for mental health during the fiscal year. (3) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and rehabilitative needs of disabled veterans within distinct programs or facilities shall be measured for veterans with spinal cord dysfunction, traumatic brain injury, blindness, or prosthetics and sensory aids as follows (with all such data to be provided by geographic service area and totaled nationally):(A) For spinal cord injury and dysfunction specialized centers and for blind rehabilitation specialized centers, the number of staffed beds and the number of full-time equivalent employees assigned to provide care at such centers. (B) For prosthetics and sensory aids, the annual amount expended. (C) For traumatic brain injury, the number of patients treated annually and the amounts expended. (4) In carrying out paragraph (1), the Secretary may not use patient outcome data as a substitute for, or the equivalent of, compliance with the requirement under that paragraph for maintenance of capacity. (5)(A) Not later than April 1 of each year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the Secretary’s compliance, by facility and by service-network, with the requirements of this subsection. Each such report shall include information on recidivism rates associated with substance-use disorder treatment. (B) In preparing each report under subparagraph (A), the Secretary shall use standardized data and data definitions. (C) Each report under subparagraph (A) shall be audited by the Inspector General of the Department, who shall submit to Congress a certification as to the accuracy of each such report. (6)(A) To ensure compliance with paragraph (1), the Under Secretary for Health shall prescribe objective standards of job performance for employees in positions described in subparagraph (B) with respect to the job performance of those employees in carrying out the requirements of paragraph (1). Those job performance standards shall include measures of workload, allocation of resources, and quality-of-care indicators. (B) Positions described in this subparagraph are positions in the Veterans Health Administration that have responsibility for allocating and managing resources applicable to the requirements of paragraph (1). (C) The Under Secretary shall develop the job performance standards under subparagraph (A) in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Committee on Care of Severely Chronically Mentally Ill Veterans. (c) The Secretary shall ensure that each primary care health care facility of the Department develops and carries out a plan to provide mental health services, either through referral or direct provision of services, to veterans who require such services.

38 U.S.C. § 1706A Remediation of medical service lines

(a) In General.—Not later than 30 days after determining under section 1703(e)(1) of this title that a medical service line of the Department is providing hospital care, medical services, or extended care services that does not comply with the standards for quality established by the Secretary, the Secretary shall submit to Congress an assessment of the factors that led the Secretary to make such determination and a plan with specific actions, and the time to complete them, to be taken to comply with such standards for quality, including the following:(1) Increasing personnel or temporary personnel assistance, including mobile deployment teams. (2) Special hiring incentives, including the Education Debt Reduction Program under subchapter VII of chapter 76 of this title and recruitment, relocation, and retention incentives. (3) Utilizing direct hiring authority. (4) Providing improved training opportunities for staff. (5) Acquiring improved equipment. (6) Making structural modifications to the facility used by the medical service line. (7) Such other actions as the Secretary considers appropriate. (b) Responsible Parties.—In each assessment submitted under subsection (a) with respect to a medical service line, the Secretary shall identify the individuals at the Central Office of the Veterans Health Administration, the facility used by the medical service line, and the central office of the relevant Veterans Integrated Service Network who are responsible for overseeing the progress of that medical service line in complying with the standards for quality established by the Secretary. (c) Interim Reports.—Not later than 180 days after submitting an assessment under subsection (a) with respect to a medical service line, the Secretary shall submit to Congress a report on the progress of that medical service line in complying with the standards for quality established by the Secretary and any other measures the Secretary will take to assist the medical service line in complying with such standards for quality. (d) Annual Reports.—Not less frequently than once each year, the Secretary shall—(1) submit to Congress an analysis of the remediation actions and costs of such actions taken with respect to each medical service line with respect to which the Secretary submitted an assessment and plan under subsection (a) in the preceding year, including an update on the progress of each such medical service line in complying with the standards for quality and timeliness established by the Secretary and any other actions the Secretary is undertaking to assist the medical service line in complying with standards for quality as established by the Secretary; and (2) publish such analysis on the internet website of the Department.

38 U.S.C. § 1707 Limitations

(a) Funds appropriated to carry out this chapter may not be used for purposes that are inconsistent with the Assisted Suicide Funding Restriction Act of 1997 (42 U.S.C. 14401 et seq.). (b) The Secretary may furnish sensori-neural aids only in accordance with guidelines prescribed by the Secretary.

38 U.S.C. § 1708 Temporary lodging

(a) The Secretary may furnish persons described in subsection (b) with temporary lodging in a Fisher house or other appropriate facility in connection with the examination, treatment, or care of a veteran under this chapter or, as provided for under subsection (e)(5), in connection with benefits administered under this title. (b) Persons to whom the Secretary may provide lodging under subsection (a) are the following:(1) A veteran who must travel a significant distance to receive care or services under this title. (2) A member of the family of a veteran and others who accompany a veteran and provide the equivalent of familial support for such veteran. (c) In this section, the term “Fisher house” means a housing facility that—(1) is located at, or in proximity to, a Department medical facility; (2) is available for residential use on a temporary basis by patients of that facility and others described in subsection (b)(2); and (3) is constructed by, and donated to the Secretary by, the Zachary and Elizabeth M. Fisher Armed Services Foundation. (d) The Secretary may establish charges for providing lodging under this section. The proceeds from such charges shall be credited to the medical services account and shall be available until expended for the purposes of providing such lodging. (e) The Secretary shall prescribe regulations to carry out this section. Such regulations shall include provisions—(1) limiting the duration of lodging provided under this section; (2) establishing standards and criteria under which charges are established for such lodging under subsection (d); (3) establishing criteria for persons considered to be accompanying a veteran under subsection (b)(2); (4) establishing criteria for the use of the premises of temporary lodging facilities under this section; and (5) establishing any other limitations, conditions, and priorities that the Secretary considers appropriate with respect to lodging under this section.

38 U.S.C. § 1709 Comprehensive policy on reporting and tracking sexual assault incidents and other safety incidents

(a) Policy Required.—(1) Not later than September 30, 2012, the Secretary shall develop and implement a centralized and comprehensive policy on the reporting and tracking of sexual assault incidents and other safety incidents that occur at each medical facility of the Department, including—(A) suspected, alleged, attempted, or confirmed cases of sexual assault, regardless of whether such assaults lead to prosecution or conviction; (B) criminal and purposefully unsafe acts; (C) alcohol or substance abuse related acts (including by employees of the Department); and (D) any kind of event involving alleged or suspected abuse of a patient. (2) In developing and implementing a policy under paragraph (1), the Secretary shall consider the effects of such policy on—(A) the use by veterans of mental health care and substance abuse treatments; and (B) the ability of the Department to refer veterans to such care or treatment. (b) Scope.—The policy required by subsection (a) shall cover each of the following:(1) For purposes of reporting and tracking sexual assault incidents and other safety incidents, definitions of the terms—(A) “safety incident”; (B) “sexual assault”; and (C) “sexual assault incident”. (2)(A) The development and use of specific risk-assessment tools to examine any risks related to sexual assault that a veteran may pose while being treated at a medical facility of the Department, including clear and consistent guidance on the collection of information related to—(i) the legal history of the veteran; and (ii) the medical record of the veteran. (B) In developing and using tools under subparagraph (A), the Secretary shall consider the effects of using such tools on the use by veterans of health care furnished by the Department. (3) The mandatory training of employees of the Department on security issues, including awareness, preparedness, precautions, and police assistance. (4) The mandatory implementation, use, and regular testing of appropriate physical security precautions and equipment, including surveillance camera systems, computer-based panic alarm systems, stationary panic alarms, and electronic portable personal panic alarms. (5) Clear, consistent, and comprehensive criteria and guidance with respect to an employee of the Department communicating and reporting sexual assault incidents and other safety incidents to—(A) supervisory personnel of the employee at—(i) a medical facility of the Department; (ii) an office of a Veterans Integrated Service Network; and (iii) the central office of the Veterans Health Administration; and (B) a law enforcement official of the Department. (6) Clear and consistent criteria and guidelines with respect to an employee of the Department referring and reporting to the Office of Inspector General of the Department sexual assault incidents and other safety incidents that meet the regulatory criminal threshold prescribed under sections 901 and 902 of this title. (7) An accountable oversight system within the Veterans Health Administration that includes—(A) systematic information sharing of reported sexual assault incidents and other safety incidents among officials of the Administration who have programmatic responsibility; and (B) a centralized reporting, tracking, and monitoring system for such incidents. (8) Consistent procedures and systems for law enforcement officials of the Department with respect to investigating, tracking, and closing reported sexual assault incidents and other safety incidents. (9) Clear and consistent guidance for the clinical management of the treatment of sexual assaults that are reported more than 72 hours after the assault. (c) Updates to Policy.—The Secretary shall review and revise the policy required by subsection (a) on a periodic basis as the Secretary considers appropriate and in accordance with best practices. (d) Annual Report.—(1) Not later than 60 days after the date on which the Secretary develops the policy required by subsection (a) and not later than October 1 of each year thereafter, 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 implementation of the policy. (2) The report required by paragraph (1) shall include—(A) the number and type of sexual assault incidents and other safety incidents reported by each medical facility of the Department; (B) a detailed description of the implementation of the policy required by subsection (a), including any revisions made to such policy from the previous year; and (C) the effectiveness of such policy on improving the safety and security of the medical facilities of the Department, including the performance measures used to evaluate such effectiveness.

38 U.S.C. § 1709A Teleconsultation

(a) Teleconsultation.—(1) The Secretary shall carry out an initiative of teleconsultation for the provision of remote mental health and traumatic brain injury assessments in facilities of the Department that are not otherwise able to provide such assessments without contracting with third-party providers or reimbursing providers through a fee basis system. (2) The Secretary shall, in consultation with appropriate professional societies, promulgate technical and clinical care standards for the use of teleconsultation services within facilities of the Department. (3) In carrying out an initiative under paragraph (1), the Secretary shall ensure that facilities of the Department are able to provide a mental health or traumatic brain injury assessment to a veteran through contracting with a third-party provider or reimbursing a provider through a fee basis system when—(A) such facilities are not able to provide such assessment to the veteran without—(i) such contracting or reimbursement; or (ii) teleconsultation; and (B) providing such assessment with such contracting or reimbursement is more clinically appropriate for the veteran than providing such assessment with teleconsultation. (b) Teleconsultation Defined.—In this section, the term “teleconsultation” means the use by a health care specialist of telecommunications to assist another health care provider in rendering a diagnosis or treatment.

38 U.S.C. § 1709B Evaluations of mental health care and suicide prevention programs

(a) Evaluations.—(1) Not less frequently than once during each period specified in paragraph (3), the Secretary shall provide for the conduct of an evaluation of the mental health care and suicide prevention programs carried out under the laws administered by the Secretary. (2) Each evaluation conducted under paragraph (1) shall—(A) use metrics that are common among and useful for practitioners in the field of mental health care and suicide prevention, including metrics applicable specifically to women; (B) identify the most effective mental health care and suicide prevention programs conducted by the Secretary, including such programs conducted at a Center of Excellence; (C) identify the cost-effectiveness of each program identified under subparagraph (B); (D) measure the satisfaction of patients with respect to the care provided under each such program; (E) propose best practices for caring for individuals who suffer from mental health disorders or are at risk of suicide, including such practices conducted or suggested by other departments or agencies of the Federal Government, including the Substance Abuse and Mental Health Services Administration of the Department of Health and Human Services; and (F) identify the mental health care and suicide prevention programs conducted by the Secretary that are most effective for women veterans and such programs with the highest satisfaction rates among women veterans. (3) The periods specified in this paragraph are the following:(A) The period beginning on the date on which the Secretary awards the contract under paragraph (4) and ending on September 30, 2018. (B) Each fiscal year beginning on or after October 1, 2018. (4) Not later than 180 days after the date of the enactment of this section, the Secretary shall seek to enter into a contract with an independent third party unaffiliated with the Department of Veterans Affairs to conduct evaluations under paragraph (1). (5) The independent third party that is awarded the contract under paragraph (4) shall submit to the Secretary each evaluation conducted under paragraph (1). (b) Annual Submission.—Not later than December 1, 2018, and each year thereafter, 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 contains the following:(1) The most recent evaluations submitted to the Secretary under subsection (a)(5) that the Secretary has not previously submitted to such Committees. (2) Any recommendations the Secretary considers appropriate.

38 U.S.C. § 1709C Assistance for child care for certain veterans receiving health care

(a) Program Required.—The Secretary shall carry out a program to provide, subject to subsection (b), assistance to qualified veterans described in subsection (c) to obtain child care so that such veterans can receive health care services described in subsection (c)(2). (b) Limitation on Period of Payments.—Assistance may be provided to a qualified veteran under this section for receipt of child care only during the period that the qualified veteran—(1) receives the types of health care services described in subsection (c)(2) at a facility of the Department; and (2) requires travel to and return from such facility for the receipt of such health care services. (c) Qualified Veterans.—For purposes of this section, a qualified veteran is a veteran who—(1) is the primary caretaker of a child or children; and (2)(A) receives from the Department—(i) regular mental health care services; (ii) intensive mental health care services; or (iii) such other intensive health care services that the Secretary determines that provision of assistance to the veteran to obtain child care would improve access to such health care services by the veteran; or (B) is in need of regular or intensive mental health care services from the Department, and but for lack of child care services, would receive such health care services from the Department. (d) Locations.—Not later than five years after the date of the enactment of the Deborah Sampson Act of 2020, the Secretary shall carry out the program at each medical center of the Department. (e) Forms of Child Care Assistance.—(1) Child care assistance under this section may include the following:(A) Stipends for the payment of child care offered by a licensed child care center (either directly or through a voucher program) that shall be, to the extent practicable, modeled after the Department of Veterans Affairs Child Care Subsidy Program established pursuant to section 630 of the Treasury and General Government Appropriations Act, 2002 (Public Law 107–67; 115 Stat. 552). (B) Direct provision of child care at an on-site facility of the Department. (C) Payments to private child care agencies. (D) Collaboration with facilities or programs of other Federal agencies. (E) Such other forms of assistance as the Secretary considers appropriate. (2) In providing child care assistance under this section, the child care needs of the local area shall be considered and the head of each medical center may select the type of care that is most appropriate or feasible for such medical center. (3) In the case that child care assistance under this section is provided as a stipend under paragraph (1)(A), such stipend shall cover the full cost of such child care.