Take Care of America’s Veterans Act

(a) Eligibility access standards.— Section 1703B of title 38, United States Code, is amended—

(1) by striking subsections (a) through (e) and inserting the following:

“(a) Access standards for community care.—

(1) For purposes of section 1703(d)(1)(D) of this title, the eligibility access standards for hospital care, medical services, or non-institutional extended care services, are as follows:

(A) With respect to primary care, mental health care, or non-institutional extended care services, the Secretary must schedule an appointment for the covered veteran with a health care provider of the Department who can provide the needed service—

(i) within 30 minutes average driving time from the residence of the veteran unless a longer average driving time has been agreed to by the veteran in consultation with a health care provider of the veteran; and

(ii) within 20 days of either the date of request for such an appointment or a later date agreed to by the veteran in consultation with a health care provider of the veteran.

(B) With respect to specialty care, the Secretary must schedule an appointment for the covered veteran with a health care provider of the Department who can provide the needed service—

(i) within 60 minutes average driving time from the residence of the veteran unless a longer average driving time has been agreed to by the veteran in consultation with a health care provider of the veteran; and

(ii) within 28 days of either the date of request for such an appointment or a later date agreed to by the veteran in consultation with a health care provider of the veteran.

(C) With respect to a covered treatment program, the Secretary must—

(i) provide to a covered veteran a screening not later than 48 hours after the date on which the veteran, or a relevant health care provider, makes a documented request for the veteran to be admitted to a covered treatment program; and

(ii) if the veteran is determined eligible for priority admission to a covered treatment program—

(I) admit the veteran to a covered treatment program not later than 48 hours after the date of such determination or give the veteran the option of seeking care at a non-Department facility pursuant to section 1792(e) of this title; or

(II) give the veteran the option of seeking care at a non-Department facility pursuant to section 1792(e) of this title.

(2) For the purposes of determining the ability of the Secretary to schedule an appointment for a covered veteran with a health care provider of the Department under paragraph (1), the Secretary shall not take into consideration the availability of telehealth appointments from the Department.

(3) In the case of a covered veteran who has had an appointment with a health care provider of the Department canceled by the Department for a reason other than either the request of the veteran or the failure of the veteran to appear as scheduled, in calculating a wait time for a subsequent appointment under the eligibility access standards established under paragraph (1), the Secretary shall calculate such wait time from the date of the request for the original, canceled appointment.

(4) If a veteran agrees to a longer average drive time or a later date under paragraph (1), the Secretary shall document the agreement to such longer average drive time or later date in the electronic health record of the veteran and provide the veteran a copy of such documentation. Such copy may be provided electronically.

(5) Paragraph (1)(C) shall not be construed to affect a covered veteran in a covered treatment program pursuant to a determination made on or before the date of the enactment of the Take Care of America’s Veterans Act.

(6)

(A) Subject to the provisions of this paragraph, subparagraphs (A) and (B) of paragraph (1) shall terminate on the date that is eight years after the date of the enactment of the Take Care of America’s Veterans Act.

(B) Not later than seven years after the date of the enactment of the Take Care of America’s Veterans Act, 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 containing—

(i) an assessment of the effects of the codification of eligibility access standards for primary care, mental health care, non-institutional extended care services, and specialty care under this subsection on the management and oversight of the Veterans Community Care Program under section 1703 of this title; and

(ii) the recommendation of the Secretary for continued codification of such standards along with a justification for such recommendation.

(C) On and after the date that is eight years after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary may not establish access standards for care and services described in subparagraph (A) or (B) of paragraph (1) that are different from the standards set forth in those subparagraphs unless, not later than 180 days before establishing such different standards—

(i) the Secretary submits to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives notification of the intent of the Secretary to establish such different standards, including a description of the changes the Secretary intends to make and the justification for such changes; and

(ii) a joint resolution of approval is enacted that approves such different standards.

(D) For purposes of this subsection, the term joint resolution of approval means only a joint resolution the matter after the resolving clause of which is as follows: “That Congress approves the access standards established by the Secretary submitted on __ relating to __.”, with the first blank space filled by the appropriate date and the second blank space filled with a description of the access standards.

(E) A joint resolution of approval shall be considered under the expedited procedures outlined in section 802 of title 5 to the same extent as a joint resolution described in subsection (a) of that section is considered.

(b) Application.— The Secretary shall ensure that the eligibility access standards established under subsection (a) apply—

(1) to all care and services within the medical benefits package of the Department to which a covered veteran is eligible under section 1703 of this title; and

(2) to all covered veterans, regardless of whether a veteran is a new or established patient.

(c) Periodic review of access standards.—

(1) Not later than three years after the date of the enactment of the Take Care of America’s Veterans Act, and not less frequently than once every three years thereafter, the Secretary shall—

(A) conduct a review of the eligibility access standards under subsection (a) in consultation with—

(i) such Federal entities as the Secretary considers appropriate, including the Department of Defense, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services;

(ii) entities and individuals in the private sector, including—

(I) veteran patients;

(II) representatives of veterans, including individual veterans and participants from veteran stakeholder organizations selected through an open and transparent process; and

(III) health care providers participating in the Veterans Community Care Program under section 1703 of this title; and

(iii) other entities that are not part of the Federal Government; and

(B) submit to the appropriate committees of Congress a report on—

(i) the findings of the Secretary with respect to the review conducted under paragraph (1); and

(ii) such recommendations as the Secretary may have with respect to the eligibility access standards under subsection (a).

(2) Chapter 10 of title 5 shall not apply to the consultation required by paragraph (1)(A).”;

(2) by striking subsection (g);

(3) by redesignating subsections (f), (h), and (i) as subsections (d), (e), and (f), respectively;

(4) in subsection (d), as redesignated by paragraph (3)—

(A) by striking “established” each place it appears; and

(B) in paragraph (1), by striking “(1) Subject to” and inserting “Compliance by Community Care Providers With Access Standards.—(1) Subject to”;

(5) in subsection (e), as so redesignated—

(A) in paragraph (1)—

(i) by striking “(1) Consistent with” and inserting “Determination Regarding Eligibility.—(1) Consistent with”; and

(ii) by striking “designated access standards established under this section” and inserting “eligibility access standards under subsection (a)”; and

(B) in paragraph (2)(B), by striking “designated access standards established under this section” and inserting “eligibility access standards under subsection (a)”; and

(6) in subsection (f), as redesignated by paragraph (2)—

(A) in the matter preceding paragraph (1), by striking “In this section” and inserting “Definitions.—In this section”; and

(B) in paragraph (2)—

(i) by striking “covered veterans” and inserting “covered veteran”;

(ii) by striking “veterans described” and inserting “a veteran described”;

(iii) by redesignating paragraphs (3) and (4) as paragraphs (4) and (5), respectively; and

(iv) by inserting after paragraph (2) the following new paragraph (3):

“(3) The term covered treatment program has the meaning given such term in section 1791 of this title.”.

(b) Conforming amendments.— Section 1703(d) of such title is amended—

(1) in paragraph (1)(D), by striking “designated access standards developed by the Secretary under section 1703B of this title” and inserting “eligibility access standards under section 1703B(a) of this title”;

(2) in paragraph (3), by striking “designated access standards developed by the Secretary under section 1703B of this title” and inserting “eligibility access standards under section 1703B(a) of this title”; and

(3) in paragraph (4), by striking “designated access standards developed by the Secretary under section 1703B of this title” and inserting “eligibility access standards under section 1703B(a) of this title”.

(a) In general.— Section 1703(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:

“(5)

(A)

(i) Except as provided in clause (iii), the Secretary shall notify each covered veteran in writing of the eligibility of such veteran for care or services under this section as soon as possible but not later than five days after the date on which the Secretary is aware that the veteran is seeking care or services and is eligible for such care or services under this section.

(ii) The Secretary is required to notify a covered veteran under clause (i) only at the start of an episode of care for such veteran.

(iii) The Secretary shall allow a covered veteran to opt out of receiving notification under clause (i).

(B) With respect to each covered veteran eligible for care or services under subsection (d), and consistent with subparagraph (A), the Secretary shall provide such veteran periodic reminders, as applicable and as the Secretary determines appropriate, of their ongoing eligibility under such subsection.

(C) Any notification or reminder under this paragraph may be provided electronically.

(6)

(A) If a request by a veteran for the Secretary to authorize care or services under this section is denied, except as provided in subparagraph (C), the Secretary shall notify the veteran in writing as soon as possible but not later than five days after the denial is made—

(i) of the reason for the denial; and

(ii) with instructions on how to appeal such denial using the clinical appeals process of the Veterans Health Administration.

(B) If a denial under subparagraph (A) is due to the Secretary meeting the eligibility access standards under section 1703B(a) of this title, notice under such subparagraph shall include an explanation of how the Secretary met such standards.

(C) The Secretary shall allow a covered veteran to opt out of receiving notification under subparagraph (A).

(D) Any notification under this paragraph may be provided electronically.”.

(b) Reports to Congress.— Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter for a period of five years, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the implementation of the amendments made by subsection (a), including—

(1) an assessment of the timeliness of the notifications required by those amendments;

(2) a description of barriers to increasing the timeliness of those notifications; and

(3) the number of veterans who opt out of receiving those notifications.

Section 1703(d) of title 38, United States Code, is amended—

(1) in paragraph (2), by adding at the end the following new subparagraphs:

“(F) The potential for improved continuity of care, including if a veteran has an established relationship with a non-Department provider and the likelihood of the covered veteran to seek and complete recommended care, including if the veteran would abstain from seeking such care if required to seek such care at a facility of the Department.

(G) Whether the covered veteran needs an attendant to provide required aid or assistance to the veteran, including for the veteran to travel to a facility of the Department.”; and

(2) by adding at the end the following new paragraph:

“(5) The Secretary shall ensure that consideration of the factors specified in paragraph (2) includes consideration of all relevant factors, is driven by clinical need, and that no single factor is required to be determinative when considering the best medical interest of a covered veteran.”.

Section 1703 of title 38, United States Code, is amended—

(1) by redesignating subsection (q) as subsection (r); and

(2) by inserting after subsection (p) the following new subsection (q):

“(q) Discussion of options for telehealth.—

(1) When discussing options for care or services for a covered veteran under this section, the Secretary shall ensure that the veteran is informed of the ability of the veteran to seek care or services via telehealth, either through a medical facility of the Department or through a non-Department provider, if—

(A) telehealth is—

(i) available to the veteran;

(ii) appropriate for the type of care or services the veteran is seeking, as determined by the Secretary; and

(iii) is acceptable to the veteran; or

(B) the care or services the veteran is seeking is only or primarily available through telehealth.

(2) Nothing in paragraph (1) shall be construed to prohibit a health care provider specified in subsection (c) from furnishing hospital care, medical services, or extended care services under this section via telehealth.”.

Section 1703D of title 38, United States Code, is amended—

(1) in subsection (a)(2), by striking “the reason for denying the claim and what, if any, additional information is required to process the claim” and inserting “the reason for denying the claim and request additional missing information, if any, that is required to process the claim”;

(2) by amending subsection (b) to read as follows:

“(b) Submittal of claims by health care entities and providers.—

(1) A health care entity or provider that furnishes hospital care, a medical service, or an extended care services under this chapter pursuant to a contract, agreement, or other arrangement shall submit to the Secretary a claim for payment for furnishing the hospital care, medical service, or extended care service not later than one year after the date on which the entity or provider furnished the hospital care, medical service, or extended care service.

(2) No health care entity or provider may seek payment from a patient if the health care entity or provider failed to comply with the timely filing requirement set forth in paragraph (1).”; and

(3) in subsection (c), by adding at the end the following new paragraph:

“(3)

(A) If the Secretary determines, based on reliable evidence, that a health care entity or provider has submitted or caused to be submitted a fraudulent claim for payment under this chapter, the Secretary may suspend such entity or provider from furnishing hospital care, medical services, or extended care services under this chapter.

(B) Before imposing a suspension under subparagraph (A) with respect to an entity or provider, the Secretary shall—

(i) provide written notice to the entity or provider identifying the basis for the proposed suspension;

(ii) afford the entity or provider an opportunity to respond within a period of 30 days; and

(iii) consider any evidence or explanation submitted by the entity or provider.

(C)

(i) The Secretary shall take all necessary actions to resolve a suspension under subparagraph (A) as soon as possible but not longer than within one year of the date of the beginning of the suspension, unless the Secretary determines and provides a written determination that an extension beyond one year is strictly necessary to protect the interests of veterans and taxpayers and to preserve the integrity of the health care delivery system of the Department.

(ii) Any extension under clause (i) of a suspension shall—

(I) be for an additional period of not longer than one year; and

(II) shall be reported to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives.

(D) The Secretary shall establish procedures for reinstatement of an entity or provider suspended under subparagraph (A) following the resolution of any fraud-related investigation or proceeding.

(E) The Secretary shall coordinate actions under this paragraph with the Office of Inspector General of the Department.

(F) The Secretary shall prescribe regulations to carry out this paragraph, including standards of evidence, notice, and appeal procedures.

(G)

(i) Not less frequently than quarterly, 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 written notification of the suspensions entered into, if any, during the preceding quarter that includes—

(I) the identity of the suspended entity or provider;

(II) the statutory or regulatory basis for the suspension;

(III) a summary of the factual findings or evidence supporting the action; and

(IV) the status of any related investigation of or referral to the Office of Inspector General of the Department or any other appropriate Federal agency.

(ii) The Secretary shall provide to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives, upon request, all records, memoranda, and communications relevant to any suspension or reinstatement action taken under this paragraph, in accordance with applicable laws related to privacy, ongoing investigations, or sensitive law enforcement information.

(iii) Failure by the Secretary to provide notice under clause (i) shall be treated as a failure to comply with a statutory reporting requirement.”.

Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter for the following five years, the Secretary of Veterans Affairs shall—

(1) conduct an audit, for the one-year period preceding the audit, of—

(A) the number of veterans eligible for care or services under section 1703 of title 38, United States Code, and the reasons for such eligibility, including multiple such reasons for veterans eligible under more than one eligibility criteria;

(B) of those veterans eligible for care or services under section 1703 of title 38, United States Code, the number of veterans who are informed of such eligibility;

(C) the number of veterans who opt to seek care or services under such section;

(D) the number of veterans who do not opt to seek care or services under such section;

(E) the timeliness of referrals for care or services under such section and the timeliness of receipt of such care or services, including whether care or services received by the veteran through a non-Department of Veterans Affairs provider had a shorter wait time than the average wait time for such care or services at a facility of the Department;

(F) the number of requests for an appeal of a denial of care or services under such section using the clinical appeals process of the Veterans Health Administration;

(G) the timeliness of each such appeal; and

(H) the outcome of each such appeal; and

(2) 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 audit conducted under paragraph (1).

(a) In general.— To the greatest extent practicable, the Secretary of Veterans Affairs shall ensure that veterans are informed in writing, for each episode of care provided under the laws administered by the Secretary, of current wait time and average drive time options for such episode of care disaggregated by care provided—

(1) in person at a facility of the Department of Veterans Affairs;

(2) via telehealth through a provider of the Department.

(3) in person through the nearest suitable non-Department facility with which the Department has a provider agreement or other arrangement for non-Department care pursuant to section 1703 of title 38, United States Code; and

(4) via telehealth through a non-Department provider with which the Department has a provider agreement or other arrangement for non-Department care pursuant to such section with the shortest wait time.

(b) Form of information.— Information provided under subsection (a)—

(1) may be provided electronically; and

(2) shall be documented in the health record of the veteran.

(c) Opt out.— The Secretary shall permit a veteran to opt out of receiving information under subsection (a).

Section 1703(a) of title 38, United States Code, as amended by section 602(a), is further amended by adding at the end the following new paragraph:

“(7) When authorizing care or services under this section, the Secretary shall ensure that the period during which such care or services may be performed by a health care provider specified in subsection (c) begins on the date that the covered veteran has the first appointment with such provider.”.

Section 1703(h) of title 38, United States Code, is amended—

(1) in paragraph (3)—

(A) by amending subparagraph (A) to read as follows:

“(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 failed to comply substantially with the provisions of the contract or with the provisions of this section and the regulations prescribed under this section, including with respect to access, quality, training, and medical documentation;

(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) by redesignating subparagraph (B) as subparagraph (D);

(C) by inserting after subparagraph (A) the following new subparagraphs:

“(B)

(i) The Secretary shall terminate a contract with an entity entered into under paragraph (1) at such a time and upon such notice to the entity as the Secretary may specify for the purposes of this section, if the entity—

(I) 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);

(II) 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; or

(III) is identified as an excluded source on the list maintained in the System for Award Management, or any successor system.

(ii) The Secretary may issue a waiver for entities subject to clause (i) for a one-year period, and such a waiver shall be reported to Congress not later than 30 days after such waiver is issued.

(C) Any entities ineligible to enter into contracts with the Department due to one or more reasons specified in this paragraph may be listed on a publicly available website of the Department or appropriate third party administrator.”;

(D) in subparagraph (D), as redesignated by subparagraph (B) of this paragraph, by striking “in subparagraph (A)” and inserting “in this paragraph”; and

(2) by adding at the end the following new paragraph:

“(7) Any contract or agreement between the Department and a third party administrator or between a third party administrator and a health care provider specified in subsection (c) that is made with respect to care or services provided under this section shall include—

(A) notice of obligations to comply with Federal laws and the consequences for failure to comply with those laws, including specific information regarding claims for payment and consequences for any false claims, statements, or documents, or concealment of a material fact;

(B) confirmation by the health care provider that they are accredited to provide any specialized services subject to the contract or agreement and that they will only use qualified staff to provide those services; and

(C) confirmation that the health care provider will identify any individuals providing specialized services or treatments included in the contract or agreement and provide proof of the licensure of those individuals to the Department.”.

Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter, the Secretary of Veterans Affairs shall publish on a publicly available and user-friendly website—

(1) the information contained in the most recent report required by section 1703(p) of title 38, United States Code; and

(2) an overview, disaggregated by region, of the waivers requested, approved, and denied under section 1703B(f)(3) of such title.

(a) Monthly checks against list of excluded individuals or entities.— The Secretary of Veterans Affairs shall ensure that third party administrators under the Veterans Community Care Program perform automated monthly checks for all community care providers against the list of excluded individuals or entities set forth by the Office of Inspector General of the Department of Health and Human Services using national provider identifier records or other unique identifiers.

(b) Revision of provider exclusion standard operating procedures.— Not later than 90 days after the date of the enactment of this Act, the Secretary shall ensure that the Office of Integrated Veteran Care or successor office revises its provider exclusion standard operating procedures to require automated matching of community care providers in the provider profile management system of the Department of Veterans Affairs to the system for award management exclusions of the General Services Administration using both taxpayer identification number and national provider identifier as identifiers.

(c) Process to identify department providers terminated or resigning from employment.— Not later than 90 days after the date of the enactment of this Act, the Secretary shall ensure that the Under Secretary for Health of the Department of Veterans Affairs develops a process to identify health care providers that are terminated, retire, or resign from employment with the Department for quality of care concerns or while under investigation for quality of care concerns so those health care providers can be prevented from participating in the Veterans Community Care Program.

(d) Update of information on providers.— Not later than one year after the date of the enactment of this Act, the Secretary, through the Office of Integrated Veteran Care or successor office, shall develop a process to ensure that third party administrators regularly, not less frequently than quarterly—

(1) update their lists of community care providers to reflect accurate provider contact information;

(2) annotate providers that are not currently accepting patients under the Veterans Community Care Program; and

(3) remove providers from the provider profile management system that—

(A) are on the list of excluded individuals or entities set forth by the Office of Inspector General of the Department of Health and Human Services;

(B) are in the system for award management exclusions of the General Services Administration; or

(C) have been terminated from employment with the Department of Veterans Affairs due to quality of care concerns or left such employment voluntarily, through resignation, or through retirement, while under investigation for quality of care concerns.

(e) Definitions.— In this section:

(1) Community care provider.— The term community care provider means a health care provider specified under section 1703(c) of title 38, United States Code.

(2) Veterans Community Care Program.— The term Veterans Community Care Program means the Veterans Community Care Program under section 1703 of title 38, United States Code.

(a) Development of plan.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop a comprehensive plan to better align training and incentive requirements applicable to community care providers participating in the Veterans Community Care Program and health care providers, residents, and trainees of the Department of Veterans Affairs.

(b) Elements.— The plan required under subsection (a) shall—

(1) identify existing training requirements or incentives applicable to health care providers of the Department;

(2) identify existing training requirements or incentives applicable to health care trainees or residents of the Department;

(3) identify existing training requirements or incentives applicable to community care providers;

(4) assess gaps between training requirements and incentives for health care providers of the Department, trainees or residents of the Department, and community care providers;

(5) establish standardized baseline training requirements to ensure consistency in the quality of care furnished through the Department from health care providers of the Department, trainees or residents of the Department, and community care providers; and

(6) provide a strategy, assessment of barriers, and timeline for implementing such baseline training requirements, including—

(A) through online modules and continuing medical education programs; and

(B) within such strategy—

(i) metrics to measure the effectiveness of baseline training requirements in improving clinical quality, satisfaction of veterans, and health outcomes for veterans;

(ii) a mechanism to account for non-Department training that is equivalent or substantially similar to the Department training in length, scope, and content, as determined by the Secretary;

(iii) a mechanism to regularly communicate, including through direct outreach and publication online and in provider handbooks of third party administrators under the Veterans Community Care Program, requirements and expectations with respect to training;

(iv) a mechanism to track, report, and address non-compliance, to include corrective actions, which may include suspending or barring providers who are routinely non-compliant; and

(v) a mechanism to designate community care providers who routinely meet or exceed baseline training requirements as preferred providers or part of the high performing provider program of the Department, as the Secretary considers appropriate.

(c) Implementation.— Not later than one year after submission of the report required under subsection (d), the Secretary shall begin implementing the plan required under subsection (a).

(d) Report to Congress.— Not later than 180 days after the date of the enactment of this Act, 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 containing—

(1) the plan required under subsection (a);

(2) a description of identified gaps between training or incentives for providers of the Department, trainees or residents of the Department, and community care providers;

(3) the estimated costs associated with implementation of the plan; and

(4) a description of any legislative or regulatory changes necessary to carry out the plan.

(e) Annual updates.— Not later than one year after the submission of the report required by subsection (d), and annually thereafter for the following two years, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives an update—

(1) describing progress in implementing the plan required under subsection (a);

(2) assessing any measurable impacts of such implementation on quality of care; and

(3) assessing any improvements in rates of compliance with training requirements among health care providers, trainees, and residents of the Department and community care providers.

(f) Definitions.— In this section:

(1) Community care provider.— The term community care provider means a health care provider specified under section 1703(c) of title 38, United States Code.

(2) Training.— The term training includes training relating to—

(A) veteran-specific cultural competency;

(B) health conditions related to military service, including toxic exposures, post-traumatic stress disorder, traumatic brain injury, and military sexual trauma;

(C) suicide prevention;

(D) pain management and opioid safety; and

(E) any other matter the Secretary determines appropriate.

(3) Veterans Community Care Program.— The term Veterans Community Care Program means the Veterans Community Care Program under section 1703 of title 38, United States Code.

(a) In general.— The Secretary of Veterans Affairs shall include in each contract or agreement used to provide care or services through the Veterans Community Care Program provisions requiring the contractor and any subcontractor or participating provider to provide government officials, including the Office of the Inspector General of the Department of Veterans Affairs, access, within a reasonable time and manner, to records, materials, documents, data, and personnel necessary to conduct audits, inspections, evaluations, or investigations related to such care or services.

(b) Third party administrators.—

(1) Requirement.— The Secretary shall require third party administrators under the Veterans Community Care Program to include provisions in agreements with participating providers that are equivalent to the provisions required under subsection (a).

(2) Notification.— Notification of the requirements under this section and any other related information as the Secretary determines appropriate shall be included in the provider handbooks of third party administrators under the Veterans Community Care Program.

(c) Standard contract language.— The Secretary shall establish standard contract language under this section in consultation with the Inspector General of the Department of Veterans Affairs.

(d) Veterans Community Care Program defined.— In this section, the term Veterans Community Care Program means the Veterans Community Care Program under section 1703 of title 38, United States Code.

(a) Establishment.— Chapter 17 of title 38, United States Code, is amended by adding at the end the following new subchapter:

In this subchapter:

“(1) Activities of daily living.— The term activities of daily living means specific personal care activities that are required for basic daily maintenance and sustenance, to include eating, toileting, bathing, grooming, dressing and undressing, and mobility.

(2) Covered treatment program.—

(A) In general.— The term covered treatment program—

(i) means—

(I) a mental health residential rehabilitation treatment program of the Department; or

(II) a program of the Department for residential care for mental health and substance use disorders;

(ii) includes—

(I) the programs designated as of the date of the enactment of the Take Care of America’s Veterans Act as domiciliary residential rehabilitation treatment programs; and

(II) any programs designated as domiciliary residential rehabilitation treatment programs on or after such date of enactment; and

(iii) does not include—

(I) Compensated Work Therapy Transition Residence programs of the Department; or

(II) Department or non-Department programs in which more than 20 percent of the care provided is provided through telehealth.

(B) Accreditation.— A program described in subparagraph (A) must maintain accreditation by the Commission on Accreditation of Rehabilitation Facilities and the Joint Commission.

(3) Covered veteran.— The term covered veteran means a veteran described in section 1703(b) of this title.

(4) Evidence-based treatment.— The term evidence-based treatment means treatment provided in accordance with the Department of Veterans Affairs/Department of Defense Clinical Practice Guidelines for Mental Health and Substance Use Disorder, or any successor similar guidelines.

(5) Social support systems.— The term social support systems, with respect to a covered veteran—

(A) means—

(i) a member of the family of the covered veteran, including a parent, spouse, child, step-family member, or extended family member; or

(ii) an individual who lives with the veteran but is not a member of the family of the veteran; and

(B) does not include a facility-organized peer support program.

(a) Standardized screening process.— Not later than one year after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall establish a standardized screening process to determine, based on clinical need, whether a covered veteran satisfies criteria for priority or routine admission to a covered treatment program.

(b) Eligibility criteria for priority admission.—

(1) In general.— Under the standardized screening process required by subsection (a), a covered veteran shall be eligible for priority admission to a covered treatment program if the covered veteran meets criteria established by the Secretary that shall include any of the following:

(A) A clinical assessment of the symptoms of the veteran, including symptoms that—

(i) significantly affect activities of daily life; and

(ii) increase the risk of adverse outcomes, such as overdose, suicide, self-harm, or an unsafe living situation.

(B) The lack of availability and applicability of other treatment options.

(C) Whether the veteran has a recent suicide or overdose attempt.

(D) Whether the veteran is determined to be a high risk for suicide or overdose.

(E) Whether the veteran has a demonstrated history of non-responsiveness, relapse, or inability to find recovery from two other completed courses of treatment, such as outpatient or intensive outpatient treatment, through a program that—

(i) is licensed by a State;

(ii) is accredited by the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission; and

(iii) provides evidence-based treatment.

(F) Such other criteria as the Secretary determines appropriate, in consultation with Congress.

(2) Consideration.— In making a determination that a covered veteran meets criteria established by the Secretary under paragraph (1) for priority admission to a covered treatment program, the Secretary shall—

(A) consider any referral of a health care provider of a covered veteran; and

(B) ensure that consideration of such criteria includes consideration of all relevant factors, is driven by clinical need, and that no single factor is required to be determinative when considering the best medical interest of a covered veteran.

(3) Provision of higher-level care.— The Secretary shall provide immediate and clinically necessary care under other authorities available to the Secretary to any covered veteran who is not clinically recommended for admission to a covered treatment program based on the need for a higher level of care, such as being at a high acute risk for suicide.

(c) Screening for traumatic brain injury.— Under the standardized screening process required by subsection (a), the Secretary shall ensure a covered veteran is screened at an appropriate time for potential mild, moderate, or severe traumatic brain injury.

(d) Considerations.— In making placement decisions in a covered treatment program for veterans who meet criteria for priority or routine admission, the Secretary shall—

(1) consider the input of the covered veteran with respect to the—

(A) program specialty, subtype, and treatment track offered to the covered veteran; and

(B) geographic placement of the covered veteran, including proximity to the current residence, time zone, or geographic region of the covered veteran;

(2) maximize the proximity of the covered veteran to social support systems; and

(3) to the greatest extent practicable, place the veteran in a covered treatment program located within the same time zone and geographic region as the residence of the veteran at the time of admission.

(e) Conditions under which care shall be furnished through non-Department providers.—

(1) Priority admission.— If the Secretary determines a covered veteran is eligible for priority admission to a covered treatment program pursuant to the standardized screening process required by subsection (a) and the Secretary is unable to admit such covered veteran to a covered treatment program at a facility of the Department in a manner that complies with the requirements under subsection (d) and section 1703B(a)(1)(C) of this title, the Secretary shall offer the covered veteran the option to receive care at a non-Department facility that—

(A) can admit the covered veteran within the period required by section 1703B(a)(1)(C)(ii)(I) of this title;

(B) is party to a contract or agreement with the Department or enters into such a contract or agreement under which the Department furnishes a program that is equivalent to a covered treatment program to a veteran through such non-Department facility;

(C) is licensed by a State;

(D) is accredited by the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission; and

(E) provides evidence-based treatment.

(2) Routine admission.— If the Secretary determines a covered veteran is eligible for routine admission to a covered treatment program pursuant to the standardized screening process required by subsection (a) and the Secretary is unable to admit such covered veteran to a covered treatment program at a facility of the Department in a manner that complies with the requirements under section 1703B(a)(1)(C) of this title with respect to routine admission, the Secretary shall offer the covered veteran the option to receive care at a non-Department facility that—

(A) is party to a contract or agreement with the Department or enters into such a contract or agreement under which the Department furnishes a program that is equivalent to a covered treatment program to a veteran through such non-Department facility;

(B) is licensed by a State;

(C) is accredited by the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission; and

(D) provides evidence-based treatment.

(3) Rule of construction.— This subsection shall not be construed to affect a covered veteran in a covered treatment program pursuant to a determination made on or before the date of the Take Care of America’s Veterans Act.

(a) Performance metrics.—

(1) In general.— The Secretary shall develop metrics to track, and shall subsequently track, the performance of medical facilities of the Department, Veterans Integrated Service Networks, and non-Department facilities in meeting the requirements for—

(A) screening, under section 1792 of this title, for a covered treatment program;

(B) timely admission, under section 1792 of this title, to a covered treatment program pursuant to such screening; and

(C) adherence to evidence-based treatment standards developed by the Secretary in consultation with appropriate governmental and non-governmental professional organizations with a demonstrated history of providing or accrediting programs that are substantially similar to covered treatment programs, or made of professionals who provide for such programs, including by—

(i) using placement criteria established by the American Society of Addiction Medicine; and

(ii) maintaining standards to meet accreditation by the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission.

(2) Elements.— The metrics developed under paragraph (1) shall include metrics for tracking the performance of medical facilities of the Department, Veterans Integrated Service Networks, and non-Department facilities with respect to routine and priority admission under a covered treatment program as well as adherence to evidence-based treatment standards.

(3) Consultation.— In developing metrics under paragraph (1), the Secretary shall consult with mental health and substance use disorder providers, including providers employed by the Department and those employed by non-Department entities, and ensure adherence to industry standards.

(4) Report.— Not later than one year after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House a report describing the consultation and performance metrics required under this subsection.

(b) Oversight.—

(1) In general.— The Secretary shall develop a process for systematically assessing at the facility, network, and regional level, as the Secretary considers appropriate, the quality of care delivered by facilities of the Department and non-Department facilities treating covered veterans under this section as well as a process for rectifying any identified concerns.

(2) Elements.— The processes required under paragraph (1) shall include assessments of—

(A) the extent to which providers at the facility deliver evidence-based treatments to covered veterans;

(B) clinical outcomes for covered veterans, including those outcomes assessment pursuant to a subsequent clinical screening under subsection (g)(3)(E);

(C) the ratio of licensed independent practitioners per resident;

(D) the rate of completion of training under section 1795 of this title by licensed independent practitioners;

(E) whether non-Department facilities and providers generally meet the criteria outlined in section 1792(e) of this title;

(F) the timeliness, completeness, and rate of transmission, if applicable, of medical records during and following treatment of covered veterans; and

(G) potentially wasteful, fraudulent, or inappropriate referral or billing practices.

(3) Consultation.— In developing the processes required under paragraph (1), the Secretary shall consult with relevant stakeholders, including mental health and substance use disorder providers employed by the Department and those employed by non-Department entities, and ensure adherence to industry standards.

(4) Report.— Not later than one year after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House a report describing the consultation and oversight processes required by this subsection.

(c) Placement; transportation.—

(1) Locations.— If the Secretary determines that a covered veteran is in need of residential care under a covered treatment program, the Secretary shall provide to the covered veteran a list of locations at which such covered veteran can receive such residential care that meets—

(A) the standards for screening under section 1792 of this title; and

(B) the care needs of the covered veteran, including applicable treatment tracks.

(2) Transportation coverage.—

(A) In general.— Notwithstanding any other provision of law regarding the transportation of individuals under this title, or any other law administered by the Secretary, and except as provided in subparagraph (B), the Secretary shall provide transportation, pay for, or reimburse the costs of transportation for any covered veteran who is admitted into a covered treatment program and needs transportation assistance—

(i) from the residence of the covered veteran or a facility of the Department or authorized non-Department facility that does not provide such care to another Department or non-Department facility that provides residential care covered under a covered treatment program; and

(ii) back to the residence of the covered veteran or to a facility of the Department or an authorized non-Department facility after the conclusion of a covered treatment program, if applicable.

(B) Limitations.—

(i) Costs incurred by veterans.— The Secretary shall provide reimbursement under subparagraph (A) directly to a covered veteran only for costs directly incurred by the covered veteran and pre-approved by the Department.

(ii) No coverage of transportation provided by covered treatment program.— The Secretary shall not reimburse a covered veteran for transportation provided to the covered veteran by a covered treatment program, unless for a purpose and amount approved by the Secretary.

(d) Appeals.—

(1) In general.— The Secretary shall develop a national policy and associated procedures, in accordance with the existing clinical appeals process of the Veterans Health Administration, under which a covered veteran, a representative of a covered veteran, or a provider who requests a covered veteran be admitted to a covered treatment program, including a provider of the Department or a non-Department provider, may file a clinical appeal pursuant to this subsection if the covered veteran is—

(A) denied admission into a covered treatment program; or

(B) accepted into a covered treatment program but is not offered bed placement in a timely manner.

(2) Timeliness standards for review.—

(A) In general.— The national policy and procedures developed under paragraph (1) for appeals described in such paragraph shall include timeliness standards for the Department to review and make a decision on such an appeal.

(B) Decision.— The Secretary shall review and respond to any appeal under paragraph (1) not later than 72 hours after the Secretary receives such appeal.

(3) Public guidance.— The Secretary shall develop, and make available to the public, guidance on how a covered veteran, a representative of the covered veteran, or a provider of the covered veteran can file a clinical appeal pursuant to this subsection—

(A) if the covered veteran is denied admission into a covered treatment program;

(B) if the first date on which the covered veteran may enter a covered treatment program does not comply with the eligibility access standards under section 1703B(a) of this title for care at a covered treatment program; or

(C) with respect to such other factors as the Secretary may specify.

(4) Rule of construction.— Nothing in this subsection may be construed as granting a covered veteran, a representative of a covered veteran, or a provider who requests a covered veteran be admitted to a covered treatment program, including a provider of the Department or a non-Department provider, the right to appeal a decision of the Secretary with respect to admission to a covered treatment program to the Board of Veterans’ Appeals under chapter 71 of this title.

(e) Tracking of availability and wait times.—

(1) In general.— The Secretary, to the extent practicable, shall create a method for tracking availability and wait times under a covered treatment program across all facilities of the Department, Veterans Integrated Service Networks, and non-Department providers throughout the United States.

(2) Availability of information.— The Secretary shall make the information tracked under paragraph (1) available, in real time to—

(A) the mental health treatment coordinators at each facility of the Department;

(B) the leadership of each medical center of the Department;

(C) the leadership of each Veterans Integrated Service Network; and

(D) the Office of the Under Secretary for Health of the Department.

(3) Publication of information.— Not less frequently than monthly, the Secretary shall publish the information tracked under paragraph (1) on a publicly accessible website of the Department.

(f) Staffing matters.—

(1) Training.—

(A) In general.— The Secretary shall update and implement training for staff of the Department directly involved in a covered treatment program regarding referrals, screening, admission, placement decisions, and appeals for such program, including all changes to processes and guidance under such program required by this section and section 1792.

(B) Covered veterans awaiting admission.— The training under subparagraph (A) shall include procedures for the care of covered veterans awaiting admission into a covered treatment program and communication with such covered veterans and the providers of such covered veterans.

(C) Timing of training.—

(i) In general.— The Secretary shall require the training under subparagraph (A) to be completed by staff required to complete such training—

(I) not later than 60 days after beginning employment at the Department in a position that includes work directly involving a covered treatment program; and

(II) not less frequently than annually.

(ii) Tracking.— The Secretary shall track completion of training required under clause (i) by staff required to complete such training.

(2) Oversight standards.— The Secretary shall review and revise oversight standards for the leadership of the Veterans Integrated Service Networks and the Veterans Health Administration to ensure that facilities and staff of the Department are adhering to the policy on access to care of each covered treatment program.

(3) Staff coverage.— The Secretary shall not require staff of a covered treatment program to act as coverage for any other team, service, or project unrelated to the covered treatment program for a period of greater than three days per month unless such coverage is for purposes of the fourth mission of the Department or under an emergency declaration.

(g) Care coordination and follow-up care.—

(1) Continuity of care.— The Secretary shall ensure each covered veteran who is screened for admission to a covered treatment program is offered, and provided if agreed upon, care options during the period between screening of the covered veteran and admission of the covered veteran to such program to ensure the covered veteran does not experience any lapse in care.

(2) Care coordination for substance use disorder.— For a covered veteran being treated for substance use disorder, the Secretary shall—

(A) ensure there is a care plan in place during the period between any detoxification services or inpatient care received by the covered veteran and admission of the covered veteran to a covered treatment program; and

(B) communicate that care plan to the covered veteran, the primary care provider of the covered veteran, and the facility where the covered veteran is or will be residing under such program.

(3) Care planning and clinical screening.—

(A) In general.— A covered treatment program, in consultation with the covered veteran and the treating providers of the covered veteran in the covered treatment program, shall ensure the completion of a care plan and a clinical screening upon admittance to the covered treatment program and prior to discharge from the covered treatment program, which shall include an assessment of, with respect to the covered veteran—

(i) overall mental health;

(ii) risk for suicide;

(iii) risk for overdose;

(iv) housing insecurity;

(v) food insecurity;

(vi) employment;

(vii) complex medical needs and diagnoses; and

(viii) any other factors the Secretary determines necessary.

(B) Matters to be included.— The care plan required under subparagraph (A) for a covered veteran shall include details on the course of treatment for the covered veteran following completion of treatment under the covered treatment program, including recommended length of stay and any necessary follow-up care and the results of any screening conducted under such subparagraph.

(C) Length of stay.—

(i) In general.— Covered treatment programs at non-Department facilities shall submit the care plan under subparagraph (A) for a covered veteran, including the requested or recommended length of stay for the covered veteran, to the Department not later than 72 hours after the veteran is admitted to the covered treatment program.

(ii) Approval required.— Any length of stay of a covered veteran at a covered treatment program longer than 30 days or extensions of length of stay greater than a total of 30 days shall require approval by the Secretary. The Secretary shall respond to any such requests for approval within 72 hours. Any such requests that have not received a response within 72 hours shall be automatically approved on a daily basis until the Secretary responds.

(D) Sharing of care plan.— The care plan required under subparagraph (A) shall be shared with the covered veteran, the primary care provider of the covered veteran, and any other providers with which the covered veteran consents to sharing the plan.

(E) Discharge from non-Department facility.— Upon discharge of a covered veteran under a covered treatment program from a non-Department facility, and not later than 30 days after discharge, the facility shall share with the Department all care records maintained by the facility with respect to the covered veteran and shall work in consultation with the Department on the care plan of the covered veteran required under subparagraph (A).

(F) Subsequent clinical screening.— Not later than 180 days after the end of treatment of a covered veteran in a covered treatment program, the covered treatment program or a Department or non-Department provider shall conduct a subsequent clinical screening, which shall include an assessment of the factors specified in clauses (i) through (viii) of subparagraph (A) and recommendations for follow-up care as the Secretary considers appropriate.

(G) Complex medical needs.— Before, during, and after treatment in a covered treatment program, the Secretary shall provide greater engagement, coordination, and monitoring of care for covered veterans with—

(i) complex medical diagnoses, including diagnoses of dementia, spinal cord injury or disorder, epilepsy, Parkinson’s, anemia, severe mental illness, multiple sclerosis, incontinence of the bladder or bowel, mobility limitations, or impaired vision; or

(ii) complex medical needs, including chemotherapy or other oncology care, dialysis, recurring blood transfusions, or physical or occupational therapy.

(h) Data collection.— The Secretary shall consult with the Office of Research and Development of the Department, or any successor office, regarding any data the Department should consider requesting or requiring from non-Department facilities to assist with research studies and projects in which the Department is participating relating to mental health residential rehabilitation treatment programs.

(i) Reports to Congress.—

(1) Report on modifications to programs.—

(A) In general.— Not later than two years after the date of the enactment of the Take Care of America’s Veterans Act, 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 modifications made to the guidance, operation, and oversight of covered treatment programs to fulfill the requirements of this section.

(B) Elements.— The report required by subparagraph (A) shall include—

(i) an assessment of whether costs of covered treatment programs, including for residential care provided through facilities of the Department and non-Department facilities, serve as a disincentive to placement in the such a program;

(ii) a description of actions taken by the Department to address the findings and recommendations by the Secretary contained in the report under section 503(c) of the STRONG Veterans Act of 2022 (division V of Public Law 117–328; 136 Stat. 5515), including—

(I) such actions with respect to—

(aa) any new locations added for covered treatment programs;

(bb) any beds added at existing facilities of such programs; and

(cc) any additional treatment tracks or sex-specific programs created or added at facilities of the Department; and

(II) a breakdown of the number and percentage of covered veterans who are determined eligible for priority placement into a covered treatment program and the number and percentage of covered veterans who are determined eligible for routine placement into a covered treatment program; and

(iii) such recommendations as the Secretary may have for legislative or administrative action to address any funding constraints or disincentives for use of a covered treatment program.

(2) Annual report on operation of programs.—

(A) In general.— Not later than one year after the submission of the report under paragraph (1), and not less frequently than annually thereafter for the following five years, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the operation of covered treatment programs.

(B) Elements.— Subject to subparagraph (C), each report required by subparagraph (A) shall include the following:

(i) The number of covered veterans served by a covered treatment program, disaggregated by—

(I) Veterans Integrated Service Network in which the covered veteran receives care;

(II) facility, including facilities of the Department and non-Department facilities, at which the covered veteran receives care;

(III) type of residential rehabilitation treatment care received by the covered veteran under such program;

(IV) sex of the covered veteran; and

(V) race or ethnicity of the covered veteran.

(ii) Wait times under a covered treatment program for the most recent year data is available, disaggregated by—

(I) treatment track or specificity of residential rehabilitation treatment care sought by the covered veteran;

(II) sex of the covered veteran;

(III) State or territory in which the covered veteran is located;

(IV) Veterans Integrated Service Network in which the covered veteran is located; and

(V) facility of the Department at which the covered veteran seeks care.

(iii) A list of all locations of a covered treatment program and number of bed spaces at each such location, disaggregated by residential rehabilitation treatment care or treatment track provided under such program at such location.

(iv) A list of any new locations of covered treatment programs added or removed and any bed spaces added or removed during the one-year period preceding the date of the report.

(v) Average cost of a stay under a covered treatment program, including total stay average and daily average, at facilities of the Department compared to non-Department facilities.

(vi) A review of staffing needs and gaps with respect to covered treatment programs that is data-driven and aligned with industry benchmarks and standards, including—

(I) a list of facilities that had unstaffed beds or closed beds due to lack of staffing at any point in the previous year;

(II) the number of additional staff needed to staff those beds;

(III) the number of beds at each facility;

(IV) the average wait-times for the covered treatment program, disaggregated by month, during the periods of bed closures; and

(V) a list of facilities that required staff of covered treatment programs to perform duties unrelated to covered treatment programs for a period of greater than three days.

(vii) An overview of data collected pursuant to a subsequent clinical screening under subsection (g)(3)(F).

(viii) A list of health care systems without a covered treatment program and an assessment of the feasibility and advisability of opening a covered treatment program at such health care system that is aligned and justified by patient demand and market factors.

(ix) A list of health care systems that offer a covered treatment program aligned with patient demand and market factors and that have an average wait time of more than 20 days and an assessment of the feasibility and advisability of expanding such covered treatment program to lower such average wait time.

(x) Any recommendations for changes to the operation of covered treatment programs, including any policy changes, guidance changes, training changes, or other changes.

(C) Anonymity.— To ensure that the data provided under this paragraph, or some portion of that data, will not undermine the anonymity of a veteran, the Secretary shall provide such data pursuant to applicable Federal law and in a manner that is wholly consistent with applicable Federal privacy and confidentiality laws, including—

(i) section 552a of title 5 (commonly known as the “Privacy Act of 1974”);

(ii) the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191);

(iii) parts 160 and 164 of title 45, Code of Federal Regulations, or successor regulations; and

(iv) sections 5701, 5705, and 7332 of this title.

(3) Notification to Congress of beds not available due to lack of staffing.— The Secretary shall notify Congress of any covered treatment programs of the Department with more than five beds or more than ten percent of beds unavailable, closed, or reassigned due to lack of staffing, including—

(A) information on the staff needed to reopen beds that are closed;

(B) plans to recruit and retain staff;

(C) the total number of beds closed or expected to be closed;

(D) the estimated length of time until those closed beds are made available; and

(E) the current wait time for access to those beds.

(j) Third-party assessment.—

(1) In general.— Not later than two years after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall seek to enter into a contract with an appropriate entity to conduct a study of the care provided under covered treatment programs through facilities of the Department and non-Department facilities.

(2) Elements.— The study required under paragraph (1) shall include a review of—

(A) whether facilities are meeting requirements of the Department pursuant to law, regulation, or policy;

(B) staffing models used by facilities and level of adherence to those models;

(C) success rates of covered treatment programs in preventing readmittance to a covered treatment program or death by suicide or overdose within a year of discharge from the program;

(D) adherence of non-Department facilities to timelines for claim submission and record returns to the Department; and

(E) any other factors the Secretary or the appropriate entity determines relevant or appropriate to include.

(3) Completion of study.— The contract sought under paragraph (1) shall include a requirement that the appropriate entity, not later than four years after the date of the enactment of the Take Care of America’s Veterans Act, complete the study required under such paragraph and submit to the Secretary a report on the study.

(4) Action plan and commentary.— Not later than five years after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives, and publish on a publicly accessible website of the Department, a report containing—

(A) the results of the study required under paragraph (1);

(B) action plans for improvement based on the results of the study; and

(C) general commentary and feedback on the results of the study.

(5) Appropriate entity defined.— In this subsection, the term appropriate entity means—

(A) a nongovernmental entity with experience in assessing programs that deliver services provided under covered treatment programs on a large scale; or

(B) a federally funded research and development center.

(k) Revision of guidance.— The Secretary shall update the guidance of the Department on the operation of covered treatment programs to reflect each of the requirements under this section.

(l) Deadline.— Unless otherwise specified, the Secretary shall carry out each requirement under this section by not later than one year after the date of the enactment of the Take Care of America’s Veterans Act.

(m) Comptroller General review.—

(1) In general.— Not later than two years after the date of the enactment of the Take Care of America’s Veterans Act, the Comptroller General of the United States shall review access to care under a covered treatment program for covered veterans in need of residential mental health care and substance use disorder care.

(2) Elements.— The review required by paragraph (1) shall include the following:

(A) A review of wait times for covered veterans under a covered treatment program, disaggregated by—

(i) treatment track or specificity of residential rehabilitation treatment care needed;

(ii) sex of the covered veteran;

(iii) home State of the covered veteran;

(iv) home Veterans Integrated Service Network of the covered veteran; and

(v) wait times for—

(I) facilities of the Department; and

(II) non-Department facilities.

(B) A review of policy and training of the Department on screening, admission, and placement under a covered treatment program.

(C) A review of the rights of covered veterans and providers to appeal admission decisions under a covered treatment program and how the Department adjudicates appeals.

(D) When determining the facility at which a covered veteran admitted to a covered treatment program will be placed in such program, a review of how the input of the covered veteran is taken into consideration with respect to—

(i) program specialty, subtype, or treatment track offered to the covered veteran; and

(ii) the geographic placement of the covered veteran, including family- or occupation-related preferences or circumstances.

(E) A review of staffing and staffing needs and gaps of covered treatment programs, including with respect to—

(i) mental health providers and coordinators at the facility level;

(ii) staff of facilities of such programs;

(iii) staff of Veterans Integrated Service Networks; and

(iv) overall administration of such programs at the national level.

(F) A review of outcomes from Department and non-Department covered treatment programs based at least in part on the subsequent clinical screenings required under subsection (g)(3)(E).

(G) Recommendations for improvement of access by covered veterans to care under a covered treatment program, including with respect to—

(i) any new sites or types of programs needed or in development;

(ii) changes in training or policy;

(iii) changes in communications with covered veterans; and

(iv) oversight of covered treatment programs by the Department.

(a) In general.— Not later than 180 days after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall make publicly available on an appropriate website of the Department a fee schedule for each covered treatment program provided by a non-Department provider through which the Secretary furnishes care and services under section 1710 of this title.

(b) Elements.— The fee schedule required under subsection (a) for a covered treatment program shall—

(1) reflect reasonable charges for the services provided;

(2) be based on the amounts customarily paid for similar services under the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) and by commercial health insurance providers;

(3) to the greatest extent practicable, be consistent with payment rates under section 1703(i) of this title;

(4) be comprehensive to include a variety of possible types of care, services, and charges; and

(5) be sufficient to ensure a robust network of qualified community providers able to provide services under a covered treatment program to covered veterans.

(c) Coordination of payment rates.— After the date of the initial publication of the fee schedule under subsection (a), the rate paid by the Department for residential substance use disorder treatment shall be the rate provided in the fee schedule required under such subsection.

(d) Recoupment of amounts.—

(1) In general.— The Secretary shall recoup from a non-Department entity, including a third party administrator, any amount paid to such entity that exceeds the amount specified under the fee schedule under subsection (a) for the care or services provided.

(2) Limitation.— A non-Department entity shall not bill a veteran for any charges recouped under paragraph (1).

(a) In general.— Not later than one year after the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall—

(1) develop and implement a plan to ensure that health care providers caring for veterans under covered treatment programs receive and complete relevant training aligned with industry standards and practices; and

(2) submit that plan to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives.

(b) Elements of training.— Training required under subsection (a) shall—

(1) be easily accessible, no-cost, and offered in such a manner as to qualify for or fulfill continuing education requirements for health care professionals;

(2) include course modules related to military culture, post-traumatic stress disorder, the evaluation and management of suicide, traumatic brain injury, and opioid safety, or comparable course modules, as determined by the Secretary; and

(3) be offered through Department and non-Department entities or organizations.

(c) Elements of plan.— The plan required under subsection (a) shall—

(1) allow for Department or non-Department providers to receive credit for non-Department training that is equivalent or substantially similar to training required under subsection (a); and

(2) include details regarding consequences for non-compliance with training required under such plan, which may include removal from a network of providers under the Veterans Community Care Program under section 1703 of this title for a specified period of time.

(d) Consultation.— The Secretary shall consult with relevant professional organizations with respect to the content of relevant training required under subsection (a).”.

(b) Clerical amendment.— The table of sections at the beginning of such chapter is amended by adding at the end the following new items:

(a) Plan.—

(1) In general.— Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan to ensure access to mental health residential treatment programs for veterans with a spinal cord injury or disorder.

(2) Elements.— The plan required under paragraph (1) shall include—

(A) a staffing plan, which shall include a plan for how the Department will—

(i) incorporate staff from other facilities to support the pilot program required under subsection (b); and

(ii) ensure adequate staffing to support the needs of veterans with a spinal cord injury or disorder;

(B) an assessment of medical equipment needs; and

(C) an assessment of the best location to deliver treatment and health care under mental health residential treatment programs, including through the use of spinal cord injury or disorder centers, spinal cord injury or disorder spokes, and community care providers.

(b) Pilot program.—

(1) In general.— Commencing not later than 120 days after the date of the enactment of this Act, the Secretary shall carry out a pilot program to provide improved access to mental health residential treatment programs of the Department of Veterans Affairs for veterans with a spinal cord injury or disorder at not fewer than three medical facilities of the Department.

(2) Selection of locations.— In selecting sites for the pilot program under paragraph (1), the Secretary shall prioritize sites in the following areas:

(A) Areas with geographic diversity, including areas that serve veterans residing in rural or highly rural areas.

(B) Areas with a significant number of veterans with spinal cord injury or disorder.

(c) Report.— Not later than one year after the date of the enactment of this Act, 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—

(1) the implementation of the plan required under subsection (a);

(2) the initial results from the pilot program under subsection (b), including the number of unique veterans who participated in the pilot program, the cost of the pilot program, and an assessment of the effectiveness of the pilot program in increasing access to, and improving outcomes for, participants in the pilot program;

(3) plans, if any, to expand or extend the pilot program to address demand for the highly specialized treatment provided under the mental health residential treatment programs of the Department for veterans with a spinal cord injury or disorder; and

(4) Such other matters as the Secretary considers appropriate.

(a) Treatment as title 38 employees.— Section 7401 of title 38, United States Code, is amended—

(1) in paragraph (1), by inserting “psychologists,” after “chiropractors,”; and

(2) in paragraph (3), by striking “psychologists,”.

(b) Inclusion in contracts for scarce medical specialist services.— Section 7409(a) of title 38, United States Code, is amended by inserting “psychologists,” after “chiropractors,”.

(a) In general.— The Secretary of Veterans Affairs may establish a program to connect covered individuals (in this section referred to as “mentees”) with peer mentors to facilitate sharing of best practices and leadership experiences and to foster opportunities to develop knowledge and skills required to lead successfully at medical facilities of the Department (in this section referred to as the “mentorship program”).

(b) Covered individual defined.— In this section, the term covered individual means—

(1) an individual in the position of Facility Director, Chief of Staff, Associate Director of Patient Care Services, Associate Director, Assistant Director, or Deputy Director at a medical center of the Department; or

(2) any other employee of the Department who is determined by the Secretary to be an executive leader at a medical center of the Department.

(c) Eligibility.— The following employees of the Department are eligible for participation as mentees in the mentorship program:

(1) An employee appointed to a position as a covered individual who has been in that position for less than one year.

(2) A covered individual employed at a medical center of the Department (regardless of appointment commencement date) that meets one or more of the following criteria:

(A) Reports poor performance, as defined by the Secretary, on the Strategic Analytics for Improvement and Learning Value Model of the Department, or successor similar model.

(B) Reports data under section 1703C(a)(3) of title 38, United States Code, as published on the Access to Care website of the Department, or successor similar website, that—

(i) does not consistently meet the level reported in the community surrounding such medical center, as determined by the Secretary; or

(ii) does not meet a threshold level determined by the Secretary.

(C) Has one or more recommendations from a report by the Office of Inspector General of the Department of Veterans Affairs that is still open more than one year after the report was published.

(3) A covered individual employed at a medical center of the Department (regardless of appointment commencement date) who is recommended by the regional leadership overseeing such medical center.

(d) Criteria for peer mentors.— Each peer mentor to be paired with a mentee under subsection (a) shall meet each of the following criteria:

(1) Previous or current employment in the same position title as the mentee.

(2) Employment in that position for not less than two years.

(3) Employment at a medical center of the Department that reports—

(A) above average performance, as defined by the Secretary, on the Strategic Analytics for Improvement and Learning Value Model of the Department, or successor similar model; and

(B) data under section 1703C(a)(3) of title 38, United States Code, as published on the Access to Care website of the Department, or successor similar website, that exceeds the level reported in the community surrounding such medical center, as determined by the Secretary.

(e) Report.— Not later than one year after the date of the enactment of this Act, and annually thereafter for an additional three years, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the mentorship program, including—

(1) the number of mentees and peer mentors participating in the mentorship program, disaggregated by medical center of the Department;

(2) the number of mentor-mentee pairings initiated under each of the eligibility criteria outlined in paragraphs (1), (2), and (3) of subsection (c), including information on any circumstances in which multiple criteria under such paragraphs were met;

(3) a description of the actions taken by the Department to encourage communication between mentees and peer mentors;

(4) aggregated feedback from participants in the mentorship program; and

(5) the turnover rate for mentee participants in the mentorship program.

(f) Termination.— The authority under this section shall terminate on September 30, 2030.

(a) In general.— Whenever possible and practicable, if the Secretary of Veterans Affairs is issuing a posting for vacant positions at the Department of Veterans Affairs that may be filled by more than one type of professional or clinician, the Secretary shall issue postings for all possible clinicians or professionals who could fill the position.

(b) Application to certain positions.— The Secretary shall consider the requirement under subsection (a) in particular with respect to hard-to-recruit, hard-to-retain, primary care, and mental health care positions.

(a) In general.— Subchapter I of chapter 7 of title 38, United States Code, is amended by inserting after section 701 the following new section:

“702. Hiring processes.—

(a) Standardized approval process for filling vacant positions.—

(1) Process required.—

(A) In general.— The Secretary shall establish a standardized, nationwide approval process for filling vacant employment positions within the Department.

(B) Variability.— The process required by subparagraph (A) may be different for each type of employment position in the Department.

(C) Approval windows.— The process required by subparagraph (A) shall include a standardized approval window for each approval step.

(2) Delegation.— If the approval authority for a step in the hiring process established under paragraph (1) is vacant, on leave, or otherwise unable to respond to requests for approval in an appropriate timeframe, such authority for approval shall be delegated to the extent practicable to the supervisor of such approval authority or such other designee as may be specified in the chain of command.

(3) Time to fill goal.— Each window of time allotted for each approval step under paragraph (1)(C) when added together shall not exceed the goal of the Department to fill window for that employment position.

(b) Process for tentative offers of employment.— The Secretary shall develop a standardized process for issuing tentative offers of employment with the Department and such process shall require that each such offer includes a specified rate of basic pay when possible and practicable.

(c) Third-party contracts.— The Secretary may conduct laboratory testing, background clearances, and other candidate approval and vetting procedures through a contract with a third party if the Secretary determines that the contract would ensure equal or better quality or timeliness.

(d) Electronic signatures.—

(1) Authority.— The Secretary shall allow electronic signatures on any hiring, recruitment, retention, or other employment documents once a standardized process for such signatures is developed and implemented under paragraph (2).

(2) Standardized process.— The Secretary shall develop a standardized process for use of electronic signatures as described in paragraph (1), which shall include exceptions and limitations as the Secretary considers appropriate and that allows for use of electronic signatures for employment documents, including SF 1152 and related successor forms, SF 2823 and related successor forms, and SF 3102–FERS and related successor forms.

(e) Employee community building program.— The Secretary shall, to the extent practicable, establish an employee community building program that connects employees in similar positions, offices, and programs to connect with each other nationwide.”.

(b) Clerical amendment.— The table of sections at the beginning of chapter 7 of such title is amended by inserting after the item relating to section 701 the following new item:

(a) Policy required.— Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall, in accordance with the requirements of this section and the requirements of section 6502 of title 5, United States Code, establish a policy for the use of telework within the Department of Veterans Affairs.

(b) Locations.— The policy established under subsection (a) may be different for different locations, specialties, and categories of employees, as determined appropriate by the Secretary.

(c) Assessment.— In developing the policy required by subsection (a), the Secretary shall assess the following for each category of employees at the Department—

(1) staffing levels and trends over the last 5 years;

(2) exit survey data related to telework;

(3) the availability of dedicated work space at facilities of the Department to enable onsite work at a duty station;

(4) a comparison of productivity levels when duties are performed on site or through telework;

(5) telework flexibilities for comparable categories of employees in the private sector and in other Federal agencies; and

(6) particular duties that necessitate on site work.

(d) Notice and reporting.—

(1) In general.— For any change made to the policy established pursuant to subsection (a), the Secretary shall—

(A) notify all affected employees of the Department of the changes; and

(B) 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 changes.

(2) Report contents.— For each report submitted to Congress under paragraph (1)(B), the Secretary shall include the analyses for each category conducted in subsection (c) and the role of those analyses in the telework policy for each category.

(3) Deadline.— A report submitted under paragraph (1)(B) regarding a change to the policy established under subsection (a) shall be made not fewer than 90 days before the change goes into effect.

(e) Report on budgetary impact.— Not later than 1 year after the date on which the policy established pursuant to subsection (a) goes into effect, the Secretary shall submit to the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate and the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives a report on the annual budgetary impact of such policy.

(f) Effective date and changes.—

(1) Effective date of initial policy.— The initial policy established by pursuant to subsection (a) shall go into effect not later than 180 days after the date on which the policy is established.

(2) Effective date of subsequent changes.— Any change made to the policy established pursuant to subsection (a) after the effective date set forth in paragraph (1) shall take effect not less than 90 days after the date on which the change is made.

(3) Notice.— For any change made to the policy established pursuant to subsection (a) after the effective date set forth in paragraph (1), the Secretary shall—

(A) notify all affected employees of the Department of the changes; and

(B) 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 changes.

(a) In general.— Section 7411 of title 38, United States Code, is amended to read as follows:

“7411. Reimbursement of continuing professional education expenses.—

(a) Required reimbursement.— The Secretary shall reimburse any full-time physician, dentist, podiatrist, chiropractor, optometrist, psychologist, registered nurse (including any advanced practice registered nurse), or physician assistant appointed under section 7401(1) of this title not more than $1,000 per year for each such individual for expenses incurred for continuing professional education directly related to the duties and responsibilities of the position of the employee or related to the duties and responsibilities of the position or positions of the employees overseen by the employee.

(b) Authorized reimbursement.— The Secretary may reimburse any full-time licensed practical or vocational nurse (including any nurse practitioner), medical technologist, pharmacist, pharmacy technician, diagnostic radiologic technologist, or social worker appointed under section 7401(3) of this title, not more than $1,000 per year for each such individual for expenses incurred for continuing professional education directly related to the duties and responsibilities of the position of the employee or related to the duties and responsibilities of the position or positions of the employees overseen by the employee.

(c) Maximum number of individuals reimbursed.— The total number of individuals who may be reimbursed under this section may not exceed 50,000 per year.

(d) Priority reimbursements.— In providing reimbursement under subsection (a), the Secretary shall prioritize reimbursement for individuals providing direct patient care or individuals who are decision-makers for direct patient care.

(e) Report required.—

(1) In general.— Not less frequently than annually after the end of the first fiscal year following the date of the enactment of the Take Care of America’s Veterans Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives information on utilization of reimbursement under this section, including—

(A) locations at which reimbursement is claimed;

(B) position title and specialty of the individual claiming reimbursement;

(C) average amount claimed per position and specialty; and

(D) percent utilization by each position and specialty overall.

(2) Authority to include in existing report.— The information required under paragraph (1) may be submitted independently or included in another annual report to Congress.”.

(b) Clerical amendment.— The table of sections at the beginning of subchapter I of chapter 74 of title 38, United States Code, is amended by striking the item relating to section 7411 and inserting the following new item:

(a) In general.— Section 505 of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (Public Law 115–182; 38 U.S.C. 301 note) is amended—

(1) in subsection (a)—

(A) in paragraph (1)—

(i) in the matter before subparagraph (A), by striking “information,” and all that follows through “facility:” and inserting “information:”;

(ii) in subparagraph (B)—

(I) by inserting “(i)” before “The number”; and

(II) by adding at the end the following new clause:

“(ii) Information made available under this subparagraph shall be updated not less frequently than once each quarter to account for delays in data processing and shall reflect the most recently available data.”;

(iii) in subparagraph (C), by striking “vacancies, by occupation.” and inserting “positions currently undergoing a recruitment action, disaggregated by occupation and by stage of recruitment.”;

(iv) in subparagraph (E)(iii), by striking “potential hires or”; and

(v) by adding at the end the following new subparagraph:

“(F) The number of positions vacated during the quarter for which the Department has not initiated a recruitment action or is not planning to initiate a recruitment action.”;

(B) by redesignating paragraph (5) as paragraph (6);

(C) by inserting after paragraph (4) the following new paragraph (5):

“(5) Display of information.— The display of information made publicly available on a website of the Department pursuant to paragraph (1) shall be disaggregated—

(A) by departmental component;

(B) in the case of information relating to Veterans Health Administration positions, by medical facility; and

(C) in the case of information relating to Veterans Benefits Administration positions, by regional office.”; and

(D) in paragraph (6), as redesignated by subparagraph (B), by striking “shall” and all that follows and inserting the following: “shall—

“(A) review the administration of the website required under paragraph (1);

(B) develop recommendations relating to the improvement of such administration; and

(C) submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report containing—

(i) the findings of the Inspector General with respect to the most recent review conducted under subparagraph (A); and

(ii) the recommendations most recently developed under subparagraph (B).”; and

(2) by amending subsection (b) to read as follows:

“(b) Annual report.— Each year, the Secretary shall submit to Congress an annual report that includes the following:

(1) A description of the steps the Department is taking to achieve full staffing capacity.

(2) A description of the actions the Department is taking to improve the onboard timeline for facilities of the Department, including—

(A) in the case of facilities of the Veterans Health Administration, for facilities for which the duration of the onboarding process exceeds the metrics laid out in the Time to Hire Model of the Veterans Health Administration, or successor model; and

(B) in the case of the Veterans Benefits Administration, for regional offices that exceed the time-to-hire target of the Office of Personnel Management.

(3) The amount of additional funds necessary to enable the Department to reach full staffing capacity.

(4) Such recommendations for legislative or administrative action as the Secretary may have in order to achieve full staffing capacity at the Department.”.

(b) Effective date.— The amendments made by subsection (a) shall take effect on the date of the enactment of this Act and shall apply with respect to the second update under section 505(a)(3) of such Act beginning after the date of the enactment of this Act and each update thereafter.

Section 1730C of title 38, United States Code, is amended—

(1) by amending subsection (a) to read as follows:

“(a) In general.— Notwithstanding any provision of law regarding the licensure of health care professionals or the prescribing of controlled substances, a covered health care professional may practice the health care profession of the health care professional and prescribe controlled substances at any location in any State or any of the Freely Associated States (as defined in section 1724(f) of this title), regardless of where the covered health care professional or the patient is located, if the covered health care professional is using telemedicine to provide treatment or prescribe controlled substances to an individual under this chapter.”;

(2) in subsection (b), by adding at the end the following new paragraph:

“(4) A health care professional who is a contractor of the Department acting in the scope of a contract with the Department to furnish care in a facility or clinic of the Department and who has an active, current, full, and unrestricted license, registration, or certification in a State to practice the health care profession of the health care professional, excluding the following:

(A) A health care professional located outside a facility or clinic of the Department providing care through the Veterans Community Care Program under section 1703 of this title or a similar authority under the laws administered by the Secretary.

(B) A health care professional conducting disability compensation evaluations pursuant to a contract with the Department.”;

(3) in subsection (d)—

(A) by redesignating paragraph (2) as paragraph (3); and

(B) by inserting after paragraph (1) the following new paragraph (2):

“(2) State laws that may be inconsistent under paragraph (1) include—

(A) the laws of—

(i) the State of licensure, certification, or registration of the covered health care professional;

(ii) the State of practice of the covered health care professional;

(iii) the State in which the patient is located; or

(iv) the State of residence of the patient; and

(B) such laws specified under subparagraph (A) as incorporated by the Controlled Substances Act (21 U.S.C. 801 et seq.).”; and

(4) in subsection (e), striking “Nothing” and inserting “Except as provided in subsections (a) and (d), nothing.”.

(a) In general.— Beginning not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall provide to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives data on graduate medical education programs, health profession scholarship programs, and any other educational assistance programs within the Veterans Health Administration.

(b) Elements.— The data required to be provided under subsection (a) shall include, for each program, the following:

(1) The number of active participants, broken down by position or expected future position or licensure.

(2) The amount of funds spent each fiscal year.

(3) The number of participants who have completed their education and are currently completing their service requirements at the Department of Veterans Affairs.

(4) The number of participants who were previously active in the program but left the program before completing their education or service requirement during the year preceding the date on which the data is provided.

(5) An overview of outreach by the Department to prospective participants in the program.

(6) Such other information as the Secretary considers appropriate.

(c) Update and submittal of data.— The data required to be provided under subsection (a)—

(1) shall be updated not less frequently than annually; and

(2) may be submitted to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives as part of another report required by law.

(d) Initial data.— With the first iteration of data provided under subsection (a), the Secretary shall provide 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 pilot program under section 246 of the Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2018 (division J of Public Law 115–141; 38 U.S.C. 7601 note), including the current status of the pilot program and a timeline of the status of the pilot program since its initial implementation.

(a) In general.— Subchapter I of chapter 7 of title 38, United States Code, is amended by adding at the end the following new section:

“729. Strategic human capital plan.—

(a) Plan development.—

(1) Not later than September 30, 2027, the Secretary shall develop and submit to the appropriate committees of Congress a five-year strategic human capital plan to support the mission and responsibilities of the Department, disaggregated by the Veterans Health Administration, the Veterans Benefits Administration, the National Cemetery Administration, and such other administrative components of the Department as the Secretary considers necessary to carry out the mission of the Department.

(2) Not later than September 30, 2028, and each September 30 thereafter, the Secretary shall update the plan developed pursuant to paragraph (1) and extend the plan so that it covers the next period of five fiscal years commencing immediately after the date of the update.

(b) Requirements.—

(1) In developing the plan required by subsection (a), the Secretary shall take into account and document current and future projected demand for benefits and services administered by the Department, disaggregated for each component by facility location, facility type, region, administration, program office, the type of benefit or service, and such other categories as the Secretary determines appropriate.

(2) The Secretary shall develop and update the plan under subsection (a) in consultation with veterans service organizations and such other stakeholders as the Secretary considers appropriate.

(c) Contents.— The strategic human capital plan required by subsection (a) shall incorporate leading practices, including the following:

(1) A workforce gap analysis, including an assessment of—

(A) the staffing levels of each employee position needed to deliver high quality, accessible, and timely health care, benefits, and other services the Secretary considers appropriate, disaggregated by employee position, facility location, facility type, region, administration, program office, the type of benefit or service, and such other categories as the Secretary determines appropriate;

(B) how the staffing levels described in subparagraph (A) align with industry best practices in each employee position for the anticipated demand for health care, benefits, and other services described in subsection (b); and

(C) core competencies, as defined by the Secretary, and the staffing levels needed in each of these core competencies, disaggregated by employee position, facility location, facility type, region, administration, program office, the type of benefit or service and such other categories as the Secretary considers appropriate.

(2) An implementation plan that includes the following:

(A) Specific recruitment and retention goals to fulfill the staffing needs identified in the strategic human capital plan and the strategy of the Department to achieve such goals.

(B) Specific strategies—

(i) to improve workforce productivity using technological, organizational, behavioral, and such other approaches as the Secretary determines appropriate and productivity measures that are specific to employee positions and the benefits or services they provide; and

(ii) that are informed by applicable industry best practices.

(C) Specific strategies for recruiting and retaining veterans, spouses of veterans and members of the Armed Forces, family members of veterans and members of the Armed Forces, caregivers of veterans, and survivors of members of the Armed Forces as employees of the Department.

(D) Specific goals to reduce the time to hire and onboard employees of the Department and a strategy to achieve such goals, including draft legislative language for any legislative action necessary to achieve such goals, without degradation of—

(i) necessary background checks; and

(ii) measures to protect Department customer and employee safety.

(d) Annual updates.— Not later than September 30, 2028, and September 30 of each of year thereafter, the Secretary shall submit to the appropriate committees of Congress an update on the implementation of the strategic human capital plan developed pursuant to subsection (a), including an assessment by the Secretary of—

(1) the progress of the Department in implementing the strategic human capital plan;

(2) the progress of the Department in improving outcomes for veterans and their spouses, dependents, and caregivers through the delivery of high quality, accessible, and timely health care, benefits, and other services the Secretary considers appropriate using results based performance measures;

(3) changes to projected demand for benefits and services based on new legislative action or other factors, disaggregated for each component by facility location, facility type, region, administration, program office and the type of benefit or service;

(4) changes to the staffing levels included in the strategic human capital plan, including justifications for such changes, disaggregated by employee position, facility location, facility type, region, administration, program office, the type of benefit or service and such other categories as the Secretary determines appropriate;

(5) any differentiation between the staffing levels included in the strategic human capital plan and those included in the budget justification materials most recently submitted to Congress in support of the budget of the Department (as submitted with the budget of the President under section 1105(a) of title 31); and

(6) any differentiation from the Quadrennial Veterans Health Administration review required by section 7330C of this title.

(e) Comptroller General of the United States biennial reviews.— Not later than 180 days after the date on which the human capital plan is submitted to the appropriate committees of Congress pursuant to subsection (a), and not less frequently than once every 2 years thereafter, the Comptroller General of the United States shall—

(1) review the strategic human capital plan developed pursuant to subsection (a) and updated pursuant to subsection (d), as the case may be, particularly with respect to the adequacy of the plan to fulfill the mission and responsibilities of the Department; and

(2) submit to Congress the findings of the Comptroller General with respect to the review conducted pursuant to paragraph (1).

(f) 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 veterans service organization means any organization recognized by the Secretary under section 5902 of this title.”.

(b) Clerical amendment.— The table of sections at the beginning of chapter 7 of such title is amended by inserting after the item relating to section 728 the following new item:

(a) In general.— Subchapter I of chapter 7 of title 38, United States Code, as amended by section 641(a), is further amended by inserting after section 729 the following new section:

“729A. Reductions in force.—

(a) Notice required.— In any case in which the Secretary plans to carry out a reduction in force, the Secretary shall, not later than the date that is 60 days before the date on which the Secretary commences carrying out such reduction in force, submit to the appropriate committees of Congress and the employees of the Department who will be affected by the reduction in force notice of the intention of the Secretary to carry out such reduction in force.

(b) Limitation.— Notwithstanding any other provision of law, the Secretary may not carry out any reduction in force with respect to any employee who has not received the notice required under subsection (a) in the manner and within the time required by such subsection.

(c) Contents.— Notice regarding plans to carry out a reduction in force submitted pursuant to subsection (a) shall include the following:

(1) The total number of employees of the Department who will be affected by the reduction.

(2) The offices of the Department that will be affected by the reduction, including, for each such office, the following:

(A) The location of the office.

(B) The program of the Department carried out by the office.

(C) The total number of employees of the office before and after the reduction in force.

(D) The services provided by the office.

(3) A justification for the reduction in force, including how—

(A) the new staffing levels resulting from the reduction in force align with the current and future projected demand for benefits and services administered by the Department, disaggregated for each component by facility location, facility type, region, administration, program office, the type of benefit or service, and such other categories as the Secretary determines appropriate; and

(B) the reduction in force aligns with the strategic human capital plan required by section 729 of this title.

(4) Budgetary effects of the reduction in force.

(5) An assessment of the anticipated impact of the reduction in force on the delivery of benefits and services furnished by the Department and the actions the Secretary plans to take to mitigate any adverse impacts.

(d) Equal content.— A notice regarding a reduction in force sent to an employee pursuant to subsection (a) shall be the same as the notice submitted under such subsection to Congress for the same reduction in force.

(e) Administrative remedy.— Effect of Noncompliance. A reduction in force carried out with respect to an employee in violation of subsection (b) shall have no force or effect with respect to such employee until the Secretary complies with subsection (a).

(f) 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 reduction in force means any action that would have required notice under part 351 of title 5, Code of Federal Regulations, as in effect on January 1,2026.”.

(b) Clerical amendment.— The table of sections at the beginning of chapter 7 of such title, as amended by section 2(b), is further amended by inserting after the item relating to section 729 the following new item:

Section 510 of title 38, United States Code, is amended—

(1) in subsection (f)(2)—

(A) in subparagraph (D), by inserting “in improving outcomes for veterans and their spouses, dependents, and caregivers through the delivery of high quality, accessible, and timely health care, benefits, and other services the Secretary considers appropriate” before the period at the end; and

(B) by adding at the end the following new subparagraphs:

“(G) A description of how the Secretary will analyze success of the reorganization using results based performance metrics that are derived from the justification for the reorganization.

(H) A risk mitigation plan identifying significant operational, workforce, financial, information technology, patient care, and service-delivery risks reasonably anticipated by the Secretary and the actions planned to mitigate such risks.”;

(2) by redesignating subsections (e) and (f) as subsections (f) and (g), respectively; and

(3) by inserting after subsection (d) the following new subsection (e):

“(e) Not later than 180 days after the date on which the Secretary completes an administrative reorganization for which the Secretary submitted under subsection (b) a report containing a detailed plan and justification for the administrative reorganization, and not less frequently than once every 180 days thereafter until the date that is two years after the date of the completion of such administrative reorganization, 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 assessing the administrative reorganization using the performance metrics described in the detailed plan and justification pursuant to subsection (g)(2)(G).”.

Nothing in this subtitle or an amendment made by this subtitle shall be construed to have any effect on any provision of law in effect before the date of the enactment of this Act.

This subtitle may be cited as the “Veterans Infrastructure and Transformation Act of 2026” or the “VITAL Act of 2026”.

Section 8153 of title 38, United States Code, is amended—

(1) in subsection (a)(3)—

(A) in subparagraph (A), by inserting “physical” before “space”;

(B) in subparagraph (B)(i), by inserting “physical” before “space”;

(C) by striking subparagraph (E);

(D) by redesignating subparagraphs (C) and (D) as subparagraphs (D) and (E), respectively;

(E) by inserting after subparagraph (B) the following new subparagraph (C):

“(C) If the health-care resource required is physical space or common services with respect to existing buildings and is to be acquired from an institution affiliated with the Department in accordance with section 7302 of this title or another entity, the Secretary may enter into contracts or agreements for the acquisition of the space or service—

(i) without regard to any law or regulation (including any Executive order, circular, or other administrative policy) that would otherwise require the use of competitive procedures for acquiring the resource; and

(ii) if all obligations are funded through available appropriations or borne by the institution or entity, without regard to any limitations applicable to leases of the Department, if, in the case of a multi-year space-sharing agreement, the agreement—

(I) requires that payments for each fiscal year be made only from appropriated funds and available that year; and

(II) includes a provision that the Government’s obligations for future years is contingent upon availability of appropriations.”;

(F) in subparagraph (D), as redesignated by subparagraph (D) of this paragraph, by striking “subparagraph (A) or (B)” and inserting “subparagraph (A), (B), or (C)”;

(2) by adding at the end the following:

“(h) In this section:

(1) The term commercial service means a service that is offered and sold competitively in the commercial marketplace, is performed under standard commercial terms and conditions, and is procured using firm-fixed price contracts.

(2) The term common service means a commercial service necessary to maintain or operate existing physical space, including maintenance, heating, ventilation, air conditioning, electricity, energy, water, wastewater, landscaping, security, laundry, or any other service as determined by the Secretary.

(3) The term physical space means a portion of a building or parking facilities.”.

(a) In general.— The Secretary of Veterans Affairs may use commercial codes and standards instead of or in addition to Federal codes and standards in the construction or alteration of facilities of the Department of Veterans Affairs, where such commercial codes and standards do not conflict with statutory and regulatory requirements.

(b) Pilot projects.— The Secretary shall under take not fewer than three pilot projects during each of fiscal years 2027, 2028, 2029, 2030, and 2031 utilizing commercial codes and standards instead of Federal codes and standards to lease or construct facilities of the Department for major construction, minor construction, or major lease projects.

(c) Reports.— The Secretary shall submit a report to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives not later than 90 days after the end of each of fiscal years 2027, 2028, 2029, 2030, and 2031 detailing the use by the Secretary of the authority provided by subsection (a) and conduct of each pilot project required by subsection (b) that was initiated, ongoing, or completed during the fiscal year.

(d) Definitions.— In this section:

(1) Commercial codes and standards.— The term commercial codes and standards means building codes or standards of the following:

(A) The National Fire Protection Association.

(B) The International Code Council.

(C) The American Society for Testing and Materials.

(D) The American Society of Civil Engineers.

(E) Any other building code or standard, other than those described in (2), determined by the Secretary.

(2) Federal codes and standards.— The term Federal codes and standards means the following:

(A) Building codes or standards specific to one or more Federal agencies.

(B) Building codes or standards specific to the Department, including the Technical Information Library.

(C) Standards of the Federal Guidelines Institute.

(a) In general.— The Secretary of Veterans Affairs shall conduct a study on the feasibility of establishing a full-service hospital of the Department of Veterans Affairs in Alaska and Hawaii.

(b) Publication.— Not later than one year after the date of the enactment of this title, the Secretary shall publish on a publicly available website of the Department the findings of the Secretary with respect to the study conducted under subsection (a).

(a) Report.— Not later than one year after the date of the enactment of this title, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on the strategic plan for infrastructure and capital assets of the Department of Veterans Affairs, which summarizes a facility lifecycle strategy targeting modernization of owned and leased facilities and infrastructure required to mitigate increasing systemic failures, veteran and staff safety, benefits delivery interruptions, and funding associated to address emergency repairs.

(b) Elements.— The report required by subsection (a) shall cover known and projected requirements over a period of not less than 10 years for the following:

(1) Land acquisition.

(2) Operations and maintenance of facilities of the existing capital asset portfolio of the Department.

(3) Operations and maintenance of the planned future capital asset portfolio of the Department.

(4) New construction, disaggregated by type of new construction, including the following types of construction:

(A) Major construction.

(B) Minor construction.

(C) Nonrecurring maintenance.

(5) Leasing.

(6) Alternative acquisition methods, such as partnerships and donations.

(7) Activation of space.

(8) Disposal, reuse, and remediation.

(9) Facility lifecycle strategy process supporting the planning, programming delivery, management, and maintenance of the current and future capital asset portfolio of the Department.

(10) A discussion of the negative effect of the lack of stable and predictable capital asset funding on the ability of the Department to plan, staff, and execute effective capital asset management.

(11) Overview of the strategy being utilized in the approach of the Secretary to capital investment, across all the capital and leasing programs, including the approach of repair versus recapitalization, use of leasing, and other relevant strategies as deemed appropriate by the Secretary.

(12) Such other matters as the Secretary considers appropriate, including with respect to legislative or administrative action, if such actions are subject to the availability of appropriated funds.

(c) Rule of construction.— Nothing in this section or a report submitted under this section shall be construed to create or imply any financial or operational obligation beyond the availability of appropriated funds.

(a) In general.— Section 2 of the Communities Helping Invest through Property and Improvements Needed for Veterans Act of 2016 (Public Law 114–294; 38 U.S.C. 8103 note) is amended—

(1) in the section heading, by striking “Pilot”;

(2) in subsection (a), in the subsection heading, by striking “Pilot”;

(3) by striking “pilot” each place it appears;

(4) by striking subsection (i); and

(5) by redesignating subsection (j) as subsection (i).

(b) Modification of acceptance of property.— Paragraph (1) of subsection (b) of such section is amended to read as follows:

“(1) the donation aligns with—

(A) a need identified in a Strategic Capital Investment Planning process priority list, a five-year development plan, a facility master plan, or an annual capital needs inventory of the Department; or

(B) any component or phase of a need described in paragraph (1); and”.

(a) Authority.— Notwithstanding any other provision of law, the Secretary of Veterans Affairs may accept donations comprising the total cost or a portion of the cost of—

(1) minor construction projects;

(2) nonrecurring maintenance projects; or

(3) construction services relating—

(A) to minor construction projects;

(B) to nonrecurring maintenance projects;

(C) to an existing facility of the Department; or

(D) to a new facility or portion thereof of the Department.

(b) Alignment to needs.— The Secretary may accept a donation under this section only if—

(1) the donation aligns with—

(A) a need identified in a Strategic Capital Investment Planning process priority list, a five-year development plan, a facility master plan, or an annual capital needs inventory of the Department; or

(B) any component or phase of a need described in subparagraph (A);

(2) the donation is from an entity described in section 2(a)(2) of the Communities Helping Invest through Property and Improvements Needed for Veterans Act of 2016 (Public Law 114–294; 38 U.S.C. 8103 note);

(3) the Secretary determines such donation would—

(A) accelerate project completion;

(B) reduce the expense to the Department;

(C) improve facility condition; or

(D) otherwise benefit veterans;

(4) the donor enters into a formal agreement with the Secretary that includes—

(A) provisions for the Department’s oversight during performance;

(B) compliance with applicable construction codes and standards, and applicable laws and regulations;

(C) donor-provided insurance, warranties, and liability protections;

(D) the amount of the donation and the amount of the Department’s funding contribution, if any;

(E) that the donation shall not increase the cost to the Federal Government of completing such project described in subsection (a) (excluding activation and sustainment of such facility); and

(F) such other terms as the Secretary determines necessary.

(c) Streamlined requirements.— For donations under this section that do not involve transfer of real property title—

(1) the donor shall enter into an agreement with the Department that determines who is responsible to ensure environmental or historic preservation due diligence is completed;

(2) the donor shall obtain all federally required construction and facility related permits; and

(3) agreements may be simplified relative to those under section 2 of the Communities Helping Invest through Property and Improvements Needed for Veterans Act of 2016 (Public Law 114–294; 38 U.S.C. 8103 note) to reflect the nature of services or targeted contributions.

(d) Reporting.— The Secretary shall include information on donations accepted under this section in the reports required under section 2(g) of the Communities Helping Invest through Property and Improvements Needed for Veterans Act of 2016 (Public Law 114–294; 38 U.S.C. 8103 note), with separate tracking for donations under this section.

(a) Report required.— Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report detailing how the Secretary will use the authorities of section 706 of title 38, United States Code, to increase the size and performance of the acquisition workforce of the Department of Veterans Affairs.

(b) Definitions.— In this section:

(1) Acquisition workforce of the Department.— The term acquisition workforce of the Department of Veterans Affairs means personnel of the Department of Veterans Affairs occupying positions within occupational series, as defined by the Director of the Office of Personnel Management, responsible for acquisition functions, as determined by the Secretary.

(2) Appropriate committees of Congress.— The term appropriate committees of Congress means the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives.

(a) In general.— Section 8120 of title 38, United States Code, is amended to read as follows:

“8120. Reports on key capital asset investments, activities, and performance.—

(a) Capital asset investment, activities, and performance.—

(1) In general.— Not later than 30 days after the end of each fiscal year, and every 60 days thereafter until the end of the subsequent fiscal year, the Secretary shall submit to the appropriate committees of Congress a report on key capital asset investments, activities, and performance of the Department.

(2) Elements.—

(A) First report in each fiscal year.— The first report under paragraph (1) in each fiscal year shall include the following:

(i) A brief summary of work that was completed on each capital asset project that was completed in the previous fiscal year.

(ii) A brief summary of the accomplishments, impediments, and challenges experienced by the Department with respect to capital asset projects in the previous fiscal year and a description of efforts made to address any such impediments and challenges.

(iii) With respect to each capital asset project completed in such year, the following:

(I) The type of project (major construction, minor construction, nonrecurring maintenance, leases, or other category, including disposals).

(II) The estimated total cost and the actual total cost of the project.

(III) A description of the project.

(IV) The location and facility with respect to which the project was carried out.

(V) The fiscal quarter the project was expected to begin, the fiscal quarter the project began, the month and year the project was completed, and the fiscal quarter the facility in connection to such project was in use by veterans, employees of the Department, or other relevant users, as the case may be.

(iv) In the case of any capital asset project completed during the previous fiscal year with respect to which the final cost of the project (or any increment of the project) was more than 10 percent greater than the estimated cost of the project (or increment) or the completion of such project (or increment) was more than 180 days later than the planned schedule for such project (or increment)—

(I) the reason for any such overage or delay; and

(II) actions being taken to prevent any such overage or delay in future projects.

(v) A list of any capital asset projects cancelled during the previous fiscal year, including any projects in the design phase and including the reason for the cancellation.

(vi) A summary of total actual obligations for capital asset projects for the previous fiscal year, broken out by major construction, minor construction, nonrecurring maintenance, and leases from the medical facilities appropriation account of the Department.

(vii) A projected list of capital asset projects, broken out by type of project under subclause (I), that are expected to be initiated during the current fiscal year and those that are expected to be completed during the current fiscal year, which shall include the following:

(I) The type of project (major construction, minor construction, nonrecurring maintenance, leases, or other category, including disposals).

(II) The estimated total cost of the project.

(III) A description of the project.

(IV) The location and facility with respect to which the project was carried out or is expected to be carried out.

(V) The fiscal quarter the project is expected to begin, the fiscal quarter the project is expected to be completed, and the fiscal quarter the facility in connection to such project is expected to be in use by veterans, employees of the Department, or other relevant users, as the case may be.

(viii) Projected total obligations for capital asset projects for the current fiscal year, broken out by major construction, minor construction, nonrecurring maintenance, and leases, from the medical facilities appropriation account of the Department.

(ix) Such observations of best practices, impediments, and accomplishments related to the capital asset management and performance of the Department, including any legislative or administrative action, as the Secretary considers appropriate with respect to such practices, impediments, and accomplishments.

(x) Meaningful metrics that show the progress of the Department toward meeting relevant goals of the Department relating to capital asset management.

(xi) Such other matters as the Secretary considers appropriate.

(B) Subsequent reports.— Each report in a fiscal year after the first report shall include, at a minimum, relevant updates on any capital asset projects that are ongoing during that fiscal year, including any updates to information provided with respect to such projects under subparagraph (A).

(3) Matters relating to reporting costs.— In each report under paragraph (1), when reporting on costs for capital asset projects, the Secretary may include information regarding Federal requirements, including those specific to the Department, that may not exist in the non-Federal construction sector that may increase costs for capital asset projects.

(b) Super construction projects.—

(1) In general.— Not later than 30 days after the end of each fiscal year, and every 60 days thereafter until the end of that fiscal year, the Secretary shall submit to the appropriate committees of Congress a report on the super construction projects carried out by the appropriate non-Department Federal entity described in section 8103(e)(1) of this title during such year.

(2) Elements.— Each report required under paragraph (1) shall include, for each project described in such paragraph—

(A) the budgetary and scheduling status of the project, as of the last day of the most recent fiscal quarter ending before the date on which the report is required to be submitted; and

(B) the actual cost and schedule variances of the project, as of such day, compared to the planned cost and schedules for the project.

(c) Definitions.— In this section:

(1) Appropriate committees of Congress.— The term appropriate committees of Congress means—

(A) the Committee on Appropriations and the Committee on Veterans’ Affairs of the Senate; and

(B) the Committee on Appropriations and the Committee on Veterans’ Affairs of the House of Representatives.

(2) Capital asset project.— The term capital asset project means a capital asset investment or activity of the Department.

(3) Super construction project.— The term super construction project has the meaning given such term in section 8103(e)(3) of this title.”.

(b) Clerical amendment.— The table of sections at the beginning of chapter 81 of title 38, United States Code, is amended by striking the item relating to section 8120 and inserting the following new item:

Not later than 180 days after the date of enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Comptroller General of the United States, the Director of the Office of Management and Budget, and private sector stakeholders, shall develop a revised process for the procurement of major medical facility leases under chapter 81 of title 38, United States Code, and submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report that includes a description of such revised process.

(a) Submission of cost estimates for major medical facility leases with presidential budget request.— Subchapter I of chapter 81 of title 38, United States Code, is amended by inserting after section 8104 the following new section:

“8104A. Submission of cost estimates for major medical facility leases with president’s budget request.—

(a) In general.— For each major medical facility lease or prospectus-level lease for which the Secretary seeks authorization, appropriations, or prospectus approval, the Secretary shall include in the budget justification materials submitted to Congress in connection with the budget of the Department for the applicable fiscal year (as submitted with the budget of the President under section 1105(a) of title 31) a market-based cost estimate and full life-cycle cost estimate for such lease.

(b) Market-based cost estimate.— Each market-based cost estimate required under subsection (a) shall include an evaluation of—

(1) local land values;

(2) applicable construction costs; and

(3) other cost factors the Secretary determines relevant to build-to-suit facilities.

(c) Standardized methodology.—

(1) In general.— The Secretary shall adopt and apply a standardized methodology for estimating under subsection (a) the full life-cycle cost of major medical facility leases and prospectus-level leases.

(2) Required elements.— The methodology required under paragraph (1) shall include, at a minimum—

(A) base rent projections over the full lease term;

(B) tenant improvement and buildout costs based on current medical facility standards;

(C) estimated operating expenses, including utilities, maintenance, and security;

(D) annual escalation factors tied to construction cost indices, labor rates, and market trends;

(E) cost assumptions for option periods or potential renewal terms; and

(F) geographic adjustments using current regional market data to reflect location-specific construction and leasing conditions.

(d) Annual adjustment.—

(1) In general.— To reflect inflation and market escalation, the Secretary shall annually adjust each cost estimate for a lease submitted to Congress for authorization, appropriations, or prospectus approval during the period beginning on the date on which the Secretary first includes such cost estimate in the budget justification materials described in subsection (a) and ending on the projected award date for the lease.

(2) Indices.— In adjusting a cost estimate under paragraph (1), the Secretary shall use such medical construction or real estate indices as the Secretary determines appropriate.

(e) Rules of construction.—

(1) Budgetary treatment.— Nothing in this section shall be construed to alter, supersede, waive, or otherwise affect the application of the scorekeeping guidelines, including the budgetary treatment of leases under Office of Management and Budget Circular A–11 or any successor guidance.

(2) Preservation of existing budget authority requirements.— Nothing in this section shall be construed to authorize the Secretary to enter into a lease, incur an obligation, or make an expenditure except to the extent and in the amount provided in advance in appropriations Acts.

(f) Definitions.— In this section, the term “major medical facility lease” has the meaning given that term in section 8104(a)(3)(B) of this title.”.

(b) Congressional notification and plan required for cost estimates exceeding approved prospectus amounts.— Subchapter I of such chapter is further amended by inserting after section 8104A the following new section:

“8104B. Congressional notification and plan required for cost estimates exceeding approved prospectus amounts.—

(a) Price estimates required during solicitation phase.— As part of the request for lease proposals (or equivalent formal solicitation) for a major medical facility lease, the Secretary shall require offerors to provide detailed price proposals, including the cost of land (if applicable), to enable evaluation against the authorized prospectus amount.

(b) Notification required.— If the lowest responsive offer for a major medical facility lease exceeds the unserviced shell rent authorized in the approved prospectus by more than 10 percent, the Secretary shall notify the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives not later than 45 days after the date on which the Secretary determines that such offer exceeds such authorized amount.

(c) Plan required.—

(1) In general.— Not later than 60 days after notification under subsection (b) with respect to a major medical facility lease, 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 plan to address the cost discrepancy for such lease, which may include scope adjustment, value engineering, requesting additional authority, or other appropriate measures.

(2) Limitation on award.— The Secretary shall not award a major medical facility lease until the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives have received the plan required under paragraph (1) with respect to such lease.

(d) Limitation on further action.— If the Secretary is required to submit a notification under subsection (b), the Secretary may not issue a request for lease proposals for the applicable major medical facility lease until the date on which the Secretary submits the plan required under subsection (c).

(e) Rule of construction.— Nothing in this section shall be construed to authorize the Secretary to exceed any amount authorized in an approved prospectus or any amount provided in advance in an appropriations Act.”.

(c) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 8104 the following new items:

(a) Report required.— Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to Congress a report on the capital asset and information technology needs of the research and development program of the Department of Veterans Affairs.

(b) Contents.—

(1) In general.— The report required by subsection (a) shall include the following:

(A) A comprehensive summary of new facilities, renovations of existing facilities, leasing of facilities, and any other such facilities or physical infrastructure the Department requires to effectively perform its research and development functions, including projected functions.

(B) Detailed information on the information technology resources, projects, equipment, and related information technology needs, disaggregated by type of information technology funding categories, such as development or operations and maintenance, the Department requires in order to make the research and development program and activities of the Department functional and high-performing in the short-, medium-, and long-term, and those needed to enable employees of the Department to perform their research and development activities in an effective and efficient manner.

(C) Such matters as the Secretary determines relevant to maintain and further improve and advance the research and development functions of the Department through improved capital asset and information technology support.

(2) Requirements.—

(A) Facilities.—

(i) Summaries by project.— In providing information under paragraph (1)(A), the Secretary shall provide estimated summaries for each project with cost data as well as a realistic multi-year plan to design and deliver the capital asset projects, assuming required funding is provided.

(ii) Identification of projects.— The Secretary shall identify each project under paragraph (1)(A) by its project type, such as major construction, minor construction, nonrecurring maintenance, major lease, minor lease, or such other category as the Secretary determines may be appropriate.

(B) Information technology.— In providing information under paragraph (1)(B), the Secretary shall provide estimated summaries for each project or investment with individual and total cost data as well as a realistic multi-year plan to develop relevant requirements and acquire and deploy the relevant information technology services, projects, equipment, and related matters.

(C) Scope.— The scope of the report submitted under subsection (a) is on the capital asset, information technology, and other related critical support functions, excluding human capital related needs, needed for the Department to perform research and development in an effective and efficient manner.

(c) Considerations.— In preparing the report required by subsection (a), the Secretary may consider the following:

(1) The findings of the 2012 final report of the Research Infrastructure Program of the Department.

(2) Current and updated data providing the most accurate and holistic presentation of the physical infrastructure, information technology, and other relevant support function needs of the research and development program of the Department.

(3) Such other matters as the Secretary considers appropriate.

(a) Report required.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on actions the Department of Veterans Affairs is taking or plans to take to enhance the ability of the Department to prevent, detect, and report waste, fraud, and abuse occurring in capital asset projects of the Department, whether by employees, contractors, or other relevant persons or entities involved with the Department.

(b) Elements.— The report required by subsection (a) shall include the following:

(1) An assessment of whether new training or enhancements to existing training should be undertaken to improve the prevention, detection, and reporting of waste, fraud, and abuse.

(2) Recommendations for such legislative and administrative action as the Secretary determines appropriate to improve the prevention, detection, and reporting of waste, fraud, and abuse.

(3) Such other matters as the Secretary considers appropriate.

(c) Consultation.— In carrying out subsection (a), the Secretary—

(1) shall consult with the Inspector General of the Department of Veterans Affairs and the Comptroller General of the United States on matters relating to best practices and strategies to improve detection and prevention by the Department of waste, fraud, and abuse in capital asset projects and management; and

(2) may consult with such other persons and entities on such matters as the Secretary considers appropriate.

(a) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report, disaggregated by medical center or other relevant health care facility of the Department of Veterans Affairs, identifying the physical infrastructure needs of the Department to support current and future anticipated long-term care needs and models of care for veterans, including—

(1) infrastructure needed to support the delivery of long-term care for women veterans, veterans with spinal cord injuries and diseases, veterans with traumatic brain injury, veterans with unique behavioral health needs, veterans with memory loss, and other population groups with unique needs or projected future needs;

(2) information regarding the plans of the Department to provide such care as the Department builds internal capacity but space is not yet available to meet the demand for such care; and

(3) with respect to any projects needed to provide the infrastructure specified under paragraph (1)—

(A) the estimated individual project cost and total cost to accomplish those projects; and

(B) the estimated individual project timeline to accomplish each such project upon receipt of appropriate funding.

(b) Inclusion of information regarding prioritization of certain projects.— The Secretary shall include in the report required under subsection (a) information regarding how the infrastructure prioritization processes of the Department, such as the Strategic Capital Investment Planning process, or successor process, could be modified to include higher prioritization of projects that support the provision of a health care service that is not widely available, or is not available in compliance with appropriate quality or access standards, from non-Department providers.

(c) Development of report.— In developing the report required under subsection (a), the Secretary shall consult with relevant regional and national program offices of the Veterans Health Administration with responsibility for managing the various health care services covered by the report, including long-term care and care relating to spinal cord injuries and diseases, to ensure that the report contains a holistic, comprehensive, and integrated plan to address the capital asset and other space needs for the population of veterans who require those services.

(d) Indication of types of projects.— In the report required under subsection (a), the Secretary shall indicate the projects that can be most efficiently and effectively accomplished through smaller individual infrastructure projects or through a larger medical facility replacement or new site of care, as determined by the Secretary.

(a) In general.— Subchapter III of chapter 17 of title 38, United States Code, is amended by adding at the end the following new section:

“1730D. Prescription, delivery, distribution, and dispensation of controlled substance medications via telemedicine.—

(a) In general.— Notwithstanding sections 102(54) and 309(e) of the Controlled Substances Act (21 U.S.C. 802(54) and 829(e)), a covered health care professional may prescribe, deliver, distribute, and dispense a controlled substance if the covered health care professional is using telemedicine through the use of an interactive telecommunications system, including an audio-only telecommunications system when necessary, to prescribe, deliver, distribute, or dispense to a patient eligible to receive hospital care or medical services under this chapter a controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 301 et seq.), regardless of whether such covered health care professional has conducted an in-person medical examination of such patient, if—

(1) such covered health care professional—

(A) is acting in the usual course of professional practice;

(B) is registered pursuant to section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) in any State or is utilizing the registration of a facility of the Department registered pursuant to section 303(f) of such Act (21 U.S.C. 823(f));

(C) has access to medical documentation from an in-person medical evaluation of such patient in the past two years by—

(i) a covered health care professional;

(ii) a health care professional who furnished care and services under the Veterans Community Care Program under section 1703 of this title; or

(iii) a health care professional of the Department of Defense; and

(D) at the time of the telemedicine visit of the patient—

(i) has reviewed the prescription data of the individual from the electronic health record database of the Department and data from the prescription drug monitoring program for the State in which the patient is located at the time of the telemedicine encounter (if such a program exists) for at least the one-year period preceding the date of the visit or, if less than one year of data is available, for the entire period available; and

(ii) provides documentation of—

(I) such review;

(II) all successful attempts to access such databases and program; and

(III) all unsuccessful attempts to access such databases and program that resulted in the prescription of a limited supply under subsection (b); and

(2) such substance is delivered, distributed, or dispensed for a legitimate medical purpose.

(b) Authority for limited supply.—

(1) In general.— If the databases and program described in subsection (a)(1)(D) are unavailable or inaccessible at the time of a telemedicine encounter conducted by a covered health care professional, the covered health care professional may not prescribe, deliver, distribute, or dispense more than a seven-day supply of a controlled substance until the covered health care professional is able to review such databases and program.

(2) Databases unavailable or inaccessible.— If a database or program required to be reviewed under subsection (a)(1)(D) is unavailable or inaccessible for an extended period, as determined by the Secretary, a covered health care professional may provide additional seven-day supplies of a controlled substance until such database or program is accessible.

(c) Maximum supply.— The authority under this section may be used to supply a controlled substance for not more than a six-month period.

(d) Use of authority.— The Secretary shall ensure that the authority under this section is used to prevent interruptions to patient care and not as a replacement for routine in-person patient care.

(e) Regulations.—

(1) In general.— The Secretary shall establish in regulations guidelines and a process for the prescription, delivery, distribution, and dispensation of a controlled substance pursuant to subsection (a).

(2) Elements.— The Secretary shall ensure the guidelines and process described in paragraph (1)—

(A) do not restrict access of a patient to in-person care; and

(B) provide for the collection and analysis of data to determine if an individual has evidence of a prior in-person medical evaluation by a health care professional described in subsection (a)(1)(C) who would reasonably be expected to have prescribing authority based on their credential or organizational role.

(3) Initiating treatment.—

(A) In general.— The guidelines established by paragraph (1) shall prohibit a covered health care professional from initiating treatment with an opioid medication listed in schedule II or III under section 202 of the Controlled Substances Act (21 U.S.C. 812) unless the covered health care professional is providing treatment—

(i) for opioid use disorder;

(ii) for a patient receiving palliative care or enrolled in hospice care; or

(iii) for a patient who is physically located in a medical facility where the patient is receiving in-person care.

(B) Exception.— The prohibition under subparagraph (A) shall not apply to renewal or maintenance of a previously prescribed medication described in such subparagraph.

(f) Reporting.—

(1) In general.— Not later than one year after the date of the enactment of the Take Care of America’s Veterans Act, and not less frequently than annually thereafter until the termination date under subsection (g), 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 addresses the use of the authority under this section during the fiscal year preceding the date of submission of the report in each Veterans Integrated Service Network.

(2) Elements.— Each report under paragraph (1) shall indicate, at a minimum—

(A) how many patients received prescriptions for controlled substance medications through telemedicine under this section;

(B) which controlled substances are being prescribed under this section and how many prescriptions were written for each such substance;

(C) the number of individuals who received a controlled substance medication that was prescribed, delivered, distributed, or dispensed under this section without evidence of an in-person medical evaluation within the previous two years by a health care professional described in subsection (a)(1)(C); and

(D) the barriers that exist to reviewing prescription drug monitoring programs of States and how often those barriers occur.

(g) Duration.— The authority under this section shall terminate on September 30, 2031.

(h) Definitions.— In this section:

(1) The terms controlled substance, deliver, dispense, and distribute have the meanings given those terms in section 102 of the Controlled Substances Act (21 U.S.C. 802).

(2) The term covered health care professional means—

(A) a health care professional who—

(i) is—

(I) an employee of the Department appointed under section 7306, 7401, 7405, 7406, or 7408 of this title or under title 5; or

(II) operating from a facility of the Department, including a clinic of the Department;

(ii) is authorized by the Secretary to provide health care under this chapter;

(iii) is required to adhere to all standards for quality relating to the provision of health care in accordance with applicable policies of the Department;

(iv) has an active, current, full, and unrestricted license, registration, or certification or meets qualification standards set forth by the Secretary within a specified time frame; and

(v) with respect to a health care profession listed under section 7402(b) of this title, has the qualifications for such profession as set forth by the Secretary; and

(B) a health professions trainee who—

(i) is appointed under section 7405 of this title; and

(ii) is under the clinical supervision of a health care professional described in subparagraph (A).”.

(b) Clerical amendment.— The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1730C the following new item:

Paragraph (4) of section 1722A(a) of title 38, United States Code, is amended to read as follows:

“(4) Paragraph (1) does not apply—

(A) to opioid antagonists furnished under this chapter to a veteran who is at high risk for overdose of a specific medication or substance in order to reverse the effect of such an overdose; and

(B) to any limited supply prescription for medication, up to a 30-day supply of such medication, under section 1730D(b) of this title if the covered health care professional would have prescribed, delivered, distributed, or dispensed a supply for more than seven days if not for the restrictions under such section.”.

(a) In general.— The Secretary of Veterans Affairs shall develop and implement a plan to establish, to the greatest extent practicable, an interactive, online self-service module—

(1) to allow veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code—

(A) to request appointments, track referrals for health care under the laws administered by the Secretary, whether at a facility of the Department of Veterans Affairs or through a non-Department provider, and receive appointment reminders;

(B) to appeal and track decisions relating to—

(i) denials of requests for authorization for care or services under section 1703 of title 38, United States Code; or

(ii) denials of requests for care or services at facilities of the Department, including under section 1710 of such title;

(C) to compare the average wait times for appointments for the type of care sought by the veteran at facilities of the Department and with non-Department facilities and providers through which the Secretary furnishes care and services under section 1703 of such title;

(D) to compare average driving times between their residence and the nearest facility of the Department that provides the care they are seeking and between their residence and the closest non-Department provider that provides the care they are seeking and through which the Secretary furnishes care and services under section 1703 of such title; and

(E) to view a provider directory, information regarding pending medical claims, and explanations of benefits; and

(2) to implement such other matters as determined appropriate by the Secretary.

(b) Submittal of plan.—

(1) Initial plan.— Not later than 180 days after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives the plan developed under subsection (a).

(2) Biannual update.— Not less frequently than once every 180 days during the two-year period beginning on the submittal of the plan under paragraph (1), the Secretary shall brief the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives on any updates on the implementation of such plan.

(a) In general.— Chapter 3 of title 38, United States Code, is amended by adding at the end the following new section:

“326. Center for Innovation.—

(a) Establishment.— There is established within the Department a Center for Innovation (in this section referred to as the “Center”).

(b) Purpose.— The purpose of the Center is to test innovative payment and service delivery models to reduce program expenditures of the Department under chapter 17 of this title while preserving or enhancing the quality of care furnished to veterans and other eligible individuals.

(c) Identification and testing of models.—

(1) In general.— The Center shall—

(A) identify and test health care payment and service delivery models under this title, including care from non-Department providers under subchapter I of chapter 17 of this title, that have the potential to—

(i) reduce program expenditures; and

(ii) preserve or enhance the quality of care furnished to veterans;

(B) give preference to models that improve the coordination, quality, and efficiency of health care services furnished under this title; and

(C) evaluate the effect of applying such models on program expenditures and quality outcomes under this title.

(2) Included models.— The models identified and tested under paragraph (1) may include the following:

(A) Bundled payment arrangements.

(B) Preventive care initiatives.

(C) Chronic care coordination models.

(d) Selection of models.—

(1) In general.— The Secretary, acting through the Center, shall select models to be tested under subsection (b) from among those that—

(A) address a defined population for which there are demonstrated deficits in care leading to poor clinical outcomes or potentially avoidable expenditures; and

(B) are expected to reduce program costs while preserving or enhancing the quality of care furnished to veterans.

(2) Criteria.— In selecting models under paragraph (1), the Secretary shall apply criteria consistent with the model selection framework used in evidence-based criteria that the Secretary determines appropriate.

(e) Testing and evaluation.—

(1) In general.— The Secretary shall design and test each model under this section in a manner that allows for the evaluation of—

(A) changes in program expenditures;

(B) changes in quality and outcomes of care for veterans; and

(C) other factors the Secretary determines relevant to care coordination, access, and equity.

(2) Evaluation.— The Secretary shall evaluate each model under this section using scientifically valid methodologies, including control or comparison groups if practicable.

(f) Reporting.—

(1) Annual report.— Not less frequently than annually, 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 models being tested under this section and their preliminary results, including—

(A) a brief narrative description of the model explaining its intent and the proposed manner in which it is supposed to reduce expenditures and increase quality of or access to care for veterans;

(B) the number of veterans and providers participating in the model, broken down by demographics such as age, race or ethnicity, geographic location, and other characteristics as chosen by the Secretary;

(C) gross and net savings or increases to the medical services account of the Department, including in comparison to baseline budgetary assumptions in the absence of the model;

(D) an assessment of the utilization of the model, including the proportion of providers choosing to participate in the model and the proportion of veterans choosing to participate in the model, as the case may be;

(E) an assessment of quality of care and patient outcome as measured by discrete objective metrics, including changes to morbidity and mortality, changes to admission rates, changes to readmission rates, changes to population health metrics such as average blood pressure, A1C levels, body mass index, or other relevant health metrics, or other relevant clinical outcome metrics;

(F) a description of provider, stakeholder, and veteran experiences; and

(G) such other matters as the Secretary may consider relevant.

(2) Final report on models.— Not later than 180 days after completing each model under this section, 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 final report on such model, including—

(A) findings from the evaluation of such model;

(B) updated findings under paragraph (1) with respect to such model;

(C) an assessment of the fiscal impact of such model; and

(D) recommendations for expansion or termination of the use of such model.

(g) Expansion of successful models.—

(1) In general.— Except as provided in paragraph (2), the Secretary may, through rulemaking, expand the duration and scope of a model tested under this section to the extent that—

(A) the Secretary determines such expansion is expected to—

(i) reduce program expenditures without reducing quality of care; or

(ii) improve quality of care without increasing program expenditures; and

(B) the Chief Financial Officer of the Department certifies that such expansion will maintain budget neutrality.

(2) Limitation.— The Secretary shall not expand a model unless the results of the evaluation of the model under subsection (e) demonstrate that the requirements of paragraph (1) are satisfied.

(h) Cost neutrality and funding.—

(1) In general.— Implementation or expansion of any model under this section shall be conducted in a manner that is cost-neutral to the Department over the duration of the use of the model, including administrative costs.

(2) Use of available amounts.— The Secretary shall ensure that expenditures under this section are made from amounts otherwise available to the Department for medical services, community care, or medical support and compliance.

(i) Rule of construction.— Nothing in this section shall be construed to authorize the Secretary to reduce the scope or amount of benefits under this title, or to impose additional eligibility requirements, except as may be necessary to carry out an approved model under this section.”.

(b) Conforming and clerical amendments.—

(1) Conforming repeal.— Section 1703E of title 38, United States Code, is repealed.

(2) Conforming amendments.—

(A) Pilot program to improve administration of care under Veterans Community Care Program.— Section 105(a) of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118–210; 38 U.S.C. 1703 note) is amended, in the matter preceding paragraph (1), by striking “Pursuant to section 1703E of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment” and inserting “Pursuant to section 326 of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation”.

(B) Pilot program on consolidating approval process of Department of Veterans Affairs for covered dental care.— Section 106(a) of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118–210; 38 U.S.C. 1703 note) is amended, in the matter preceding paragraph (1), by striking “the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code” and inserting “the Center for Innovation established under section 326 of title 38, United States Code”.

(C) Strategic plan on value-based health care system for Veterans Health Administration; pilot program.— Section 107 of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118–210; 38 U.S.C. 1701 note) is amended—

(i) in subsection (a)(2)(A)(viii), by striking “the Center for Innovation for Care and Payment of the Department under section 1703E of title 38, United States Code” and inserting “the Center for Innovation under section 326 of title 38, United States Code”; and

(ii) in subsection (c)(1), by striking “the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code” and inserting ““the Center for Innovation under section 326 of title 38, United States Code”.

(3) Clerical amendments.—

(A) Chapter 17.— The table of sections at the beginning of chapter 17 of title 38, United States Code, is amended by striking the item relating to section 1703E.

(B) Chapter 3.— The table of sections at the beginning of chapter 3 of such title is amended by adding at the end the following new item:

(c) Comptroller General report.— Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report—

(1) on the efforts of the Center for Innovation of the Department of Veterans Affairs in fulfilling the objectives and requirements under section 326 of title 38, United States Code, as added by subsection (a); and

(2) containing such recommendations as the Comptroller General considers appropriate.

(d) Review of Veterans Community Care Program.—

(1) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, acting through the Office of Management of the Department of Veterans Affairs, shall conduct a review of all aspects of the Veterans Community Care Program.

(2) Elements.— The review required by paragraph (1) shall—

(A) identify proven management and payment best practices of the Federal Government used under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), and the TRICARE program (as defined in section 1072 of title 10, United States Code);

(B) determine what best practices, if any, identified under subparagraph (A) should be adopted and implemented by the Secretary, including those practices that would require legislative action before adoption and implementation;

(C) determine how the Secretary can improve access to care through the Veterans Community Care Program for veterans eligible for such care;

(D) identify solutions to ease administrative, legislative, and regulatory burdens and improve efficiency in the Veterans Community Care Program;

(E) identify improvements to the Veterans Community Care Program that can enhance the experience of veterans and participating entities and providers furnishing hospital care, medical services, and extended care services under the Veterans Community Care Program;

(F) review how the Secretary—

(i) identifies eligibility for and reviews, processes, and approves referrals for care under the Veterans Community Care Program;

(ii) authorizes the furnishing of services under the Veterans Community Care Program; and

(iii) receives, reviews, processes, and approves requests for payment from participating entities and providers furnishing services under the Veterans Community Care Program.

(G) assess such other factors as determined appropriate by the Secretary in consultation with Congress.

(3) Briefing and report.—

(A) Briefing.— Periodically throughout the duration of the review required under paragraph (1), but not less frequently than quarterly, the Secretary shall brief the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives on the status and preliminary findings of such review.

(B) Report.— Not later than 30 days after the conclusion of the review required 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 written report containing—

(i) a complete and unredacted list of all findings and recommendations from the review; and

(ii) any legislative, administrative, regulatory, policy, or other changes sought by the Secretary as a result of such findings.

(4) Veterans Community Care Program defined.— In this subsection, the term Veterans Community Care Program means the Veterans Community Care Program under section 1703 of title 38, United States Code.

(e) Pilot programs.—

(1) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence carrying out the pilot programs described in paragraph (2) through the Center for Innovation established by section 326 of title 38, United States Code, as added by subsection (a), and the Office of Management of the Department of Veterans Affairs.

(2) Pilot programs described.— The Secretary shall carry out the following pilot programs:

(A) A pilot program to test innovative payment models for the furnishing of preventive health services, as such term is defined in section 1701 of title 38, United States Code.

(B) A pilot program to test innovative payment models involving payment bundling for integrated care during an episode of care authorized under the Veterans Community Care Program under section 1703 of title 38, United States Code, to improve the coordination, quality, and efficiency of health care delivery under such program.

(f) Modification of independent assessments of health care delivery systems and management processes.— Subsection 1704A of title 38, United States Code, is amended—

(1) in subsection (a)(2)(I), by adding at the end the following new clause:

“(vi) To identify proven management and payment best practices of the Federal Government used under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), and the TRICARE program (as defined in section 1072 of title 10).”; and

(2) in subsection (d), by inserting “or federally funded research and development center” after “private entity”.

(a) In general.— Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs, in consultation with veterans service organizations, veterans, caregivers of veterans, employees of the Department of Veterans Affairs, and other stakeholders as determined by 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 containing recommendations for legislative or administrative action to improve the clinical appeals process of the Department with respect to timeliness, transparency, objectivity, consistency, and fairness.

(b) Inapplicability of requirements relating to Federal advisory committees.— Chapter 10 of title 5, United States Code, shall not apply to the consultation required by subsection (a).

(c) Veterans service organization defined.— In this section, the term veterans service organization means any organization recognized by the Secretary under section 5902 of title 38, United States Code.

(a) In general.— Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan on improving disability-related access to care from facilities of the Department and from non-Department facilities and providers through which the Secretary furnishes care and services under section 1703 of title 38, United States Code, for veterans with spinal cord injury or disorder.

(b) Consultation.— In developing the plan required under subsection (a), the Secretary shall consult with relevant stakeholders, including veterans service organizations who serve veterans with spinal cord injury or disorder.

(c) Elements.— The plan required under subsection (a) shall include an assessment of disability-related barriers to care at medical facilities of the Department of Veterans Affairs and through community care networks of non-Department providers for veterans with spinal cord injury or disorder and a description of the actions needed to overcome such barriers, including cost estimates, timelines for corrective action, and requests for legislative action, if any.

(d) Veterans service organization defined.— In this section, the term veterans service organization means any organization recognized by the Secretary under section 5902 of title 38, United States Code.