Mike Bost
Representative for Illinois · Republican · United States
“(B) Elements.--The Secretary, in coordination with participating critical access hospitals, shall ensure that any contract, agreement, or other arrangement entered into under subparagraph (A) establishes criteria, as the Secretary considers appropriate, to ensure-- (i) the provision of timely, safe, and high-quality health care services t…”
“(B) Elements.--The Secretary, in coordination with participating critical access hospitals, shall ensure that any contract, agreement, or other arrangement entered into under subparagraph (A) establishes criteria, as the Secretary considers appropriate, to ensure-- (i) the provision of timely, safe, and high-quality health care services t…”
“(a) In General.--Paragraph (2) of section 2306(h) of title 38, United States Code, is amended to read as follows: ``(2) If the Secretary furnishes an urn or commemorative plaque for an individual under paragraph (1), the Secretary may not provide for such individual a headstone or marker under this section, or any interment benefit under…”
“(a) In General.--Paragraph (2) of section 2306(h) of title 38, United States Code, is amended to read as follows: ``(2) If the Secretary furnishes an urn or commemorative plaque for an individual under paragraph (1), the Secretary may not provide for such individual a headstone or marker under this section, or any interment benefit under…”
“(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 communit…”
“(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 communit…”
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“``(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. ``Sec. 1793.”
“``(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.”
“``(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.”
“``(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.”
“``(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. [[Page H4592]] ``(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.”
“``(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.”
“``(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.”
“``(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 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.”
“Standardized process to determine eligibility of covered veterans for participation in certain mental health treatment programs ``(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.”
“``(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. ``Sec. 1792.”
“``(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.”
“``(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.”
“(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. Subtitle B--Mental Health Treatment Programs SEC. 621. VETERAN PARTICIPATION IN CERTAIN MENTAL HEALTH PROGRAMS. (a) Establishment.--Chapter 17 of title 38, United States Code, is amended by adding at the end the following new subchapter: ``SUBCHAPTER IX--PARTICIPATION BY VETERANS IN CERTAIN MENTAL HEALTH TREATMENT PROGRAMS ``Sec. 1791. Definitions ``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.”
“(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.”
“(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.”
“(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. SEC. 613. OVERSIGHT AUTHORITY OVER COMMUNITY CARE.”
“(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.”
“(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.”
“(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 [[Page H4591]] 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.”
“(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. SEC. 612. PROVIDER TRAINING. (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.”
“(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.”
“(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.”
“(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.”
“(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.”
“SEC. 610. PUBLICATION OF COMMUNITY CARE NETWORK SUFFICIENCY AND PAYMENT WAIVER REQUESTS AND APPROVALS. 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. SEC. 611. REQUIREMENTS RELATING TO QUALITY OF COMMUNITY CARE PROVIDERS.”
“``(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.''.”
“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.”
“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.”
“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.''. SEC. 609. UPDATES TO CONTRACTING REQUIREMENTS UNDER VETERANS COMMUNITY CARE PROGRAM.”
“(b) Form of Information.--Information provided under subsection (a)-- [[Page H4590]] (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). SEC. 608. ESTABLISHMENT OF PERIOD DURING WHICH A REFERRAL UNDER VETERANS COMMUNITY CARE PROGRAM REMAINS VALID.”
“SEC. 607. INFORMATION ON WAIT TIME AND DRIVE TIME OPTIONS FOR RECEIPT OF CARE BY VETERANS. (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.”
“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) with respect to 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).”
“``(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.''. SEC. 606. AUDIT OF REPRESENTATIVE SAMPLE OF VETERANS RECEIVING CARE AND SERVICES UNDER VETERANS COMMUNITY CARE PROGRAM.”
“``(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) 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.”
“``(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 and not later than one year after the date of such 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.”
“``(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.”
“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 service 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) 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.''. SEC. 605. EXTENSION OF DEADLINE FOR SUBMITTAL OF CLAIMS BY HEALTH CARE ENTITIES AND PROVIDERS UNDER PROMPT PAYMENT STANDARD.”
“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.”
“``(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.''. SEC. 604. DISCUSSION OF TELEHEALTH OPTIONS UNDER VETERANS COMMUNITY CARE PROGRAM.”
“CONSIDERATION UNDER VETERANS COMMUNITY CARE PROGRAM OF CONTINUITY OF CARE AND NEED FOR CAREGIVER OR ATTENDANT. 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.”
“``(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 [[Page H4589]] 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. SEC. 603.”
“``(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).”
“``(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.”
“REQUIREMENT THAT SECRETARY NOTIFY VETERANS OF ELIGIBILITY FOR CARE OR DENIAL OF REQUEST FOR CARE UNDER VETERANS COMMUNITY CARE PROGRAM. (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.”
“(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''. SEC. 602.”
“``(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.''.”
“``(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).”
“``(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.”