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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“(b) Elements of Plan.-- (1) In general.--The plan required by subsection (a) shall include-- (A) such actions, resources, technology, and process improvements as the Secretary determines necessary to ensure the Department achieves, in a timely manner, improved delivery of health care, access to health care, customer experience and service relating to the receipt of health care, and efficiency with respect to the delivery of health care; and (B) a proposed schedule and timeline to carry out such plan.”
“(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 plan to improve the process for scheduling appointments for health care from the Department of Veterans Affairs, including improvements for both patients and employees of the Department responsible for scheduling such appointments.”
“(e) Submission of Goals, Measures, and Materials.--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 shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives copies of any goals, performance measures, training materials, or outreach materials pertaining to the submission of medical documentation under this section. SEC. 318. IMPLEMENTATION OF AND REPORT ON EFFORTS OF DEPARTMENT OF VETERANS AFFAIRS TO IMPROVE HEALTH CARE APPOINTMENT SCHEDULING.”
“(c) Training.--The Secretary may establish goals and related performance measures for the completion by non- Department entities or providers of core training related to the submission to the Secretary of medical documentation under subsection (a) and may monitor the completion of such training. (d) Outreach.--The Secretary shall ensure that communications by the Secretary with non-Department entities or providers contain clear and accurate information regarding requirements for submitting medical documentation under subsection (a) and completing the core training described in subsection (c).”
“(a) In General.--The Secretary of Veterans Affairs shall ensure that each contract, agreement, or other arrangement through which the Secretary furnishes hospital care, medical services, or extended care services to eligible veterans through non-Department of Veterans Affairs entities or providers includes clear requirements, including requirements regarding timeliness, regarding the submission of medical documentation to the Secretary after a veteran receives such care or services from the non-Department entity or provider. (b) Internal Measures.--The Secretary shall establish such goals and related performance measures for medical centers of the Department as the Secretary determines appropriate in obtaining medical documentation from non-Department entities or providers under subsection (a).”
“(2) Elements.--The report required by paragraph (1) shall identify potential impacts of the Prosthetic and Rehabilitative Items and Services Formulary on-- (A) access by veterans to prosthetic and rehabilitative items and services; (B) clinician workload; (C) procurement timelines; and (D) innovation adoption. SEC. 317. IMPROVEMENT OF SUBMISSION OF MEDICAL DOCUMENTATION TO THE SECRETARY OF VETERANS AFFAIRS BY COMMUNITY CARE PROVIDERS.”
“(b) Report.-- (1) 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 report containing a comprehensive, independent, operational, and technology assessment for the implementation of the Prosthetic and Rehabilitative Items and Services Formulary established under section 1709D of title 38, United States Code, as added by subsection (a).”
“``(j) Report to Congress.--Not later than two years after the date of the enactment of this section, and annually thereafter, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report describing-- ``(1) rates of compliance by the Department with national prosthetic contracts; ``(2) open market purchasing trends of the Department; ``(3) utilization of the Formulary across facilities of the Department; and ``(4) steps taken by the Department to improve enterprise procurement efficiency.''. (2) Clerical amendment.--The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1709C the following new item: ``1709D. Prosthetic and rehabilitative items and services formulary''.”
“``(3) Implementation.--The Secretary shall ensure that the system required under paragraph (1) is implemented across all medical centers of the Department by not later than three years after the date of the enactment of this section. ``(i) Program Management.-- ``(1) In general.--The Secretary shall ensure that the Prosthetic and Sensory Aids Service of the Department maintains adequate staffing to administer the Formulary and associated procurement programs. ``(2) Staffing included.--Staffing required under paragraph (1) shall include-- ``(A) dedicated program managers for major prosthetic product categories; and ``(B) full-time clinical staff responsible for clinical evaluations and practice recommendations.”
“``(h) Enterprise Procurement and Ordering System.-- ``(1) In general.--The Secretary shall implement an enterprise electronic ordering system for prosthetic and rehabilitative items and services furnished under this section. ``(2) Systems elements.--The system required under paragraph (1) shall-- ``(A) enable the automated ordering of items included on the Formulary; ``(B) provide visibility of contract pricing and availability across all facilities of the Department; ``(C) allow enterprise loading of nationally contracted products; ``(D) provide procurement analytics to monitor compliance with national contracts and reduce open market purchasing; and ``(E) contain all data elements required for the Federal Electronic Healthcare Record in a searchable format.”
“``(3) Prior authorization for non-formulary procurement.-- The Secretary shall establish a prior authorization process for the procurement of prosthetic and rehabilitative items that are not included on the Formulary or available through a national contract. ``(4) Open market procurement.--The Secretary shall ensure that procurement of items that are not included on the Formulary or available through a national contract is permitted only if a clinician determines the item is medically necessary. ``(g) Consideration.--In developing the Formulary, the Secretary shall consider how the approach of the Pharmacy Benefits Management Services of the Department for formulary management and medication safety can be adapted to support the efficient and effective administration of the Formulary.”
“``(e) Training.--The Secretary shall ensure the availability of training on the Formulary for clinicians and other staff of the Department. ``(f) Exceptions.-- ``(1) In general.--The Secretary shall establish a process for clinicians of the Department to request, prescribe, and furnish prosthetic and rehabilitative items and services that are not included on the Formulary when medically necessary. ``(2) Monitoring of non-formulary items and services.--The Secretary shall monitor requests and prescriptions for and the furnishing of prosthetic and rehabilitative items and services under paragraph (1)-- ``(A) to ensure that such items and services are being consistently and appropriately prescribed at all facilities of the Department; and ``(B) to determine whether such items or services should be added to the Formulary.”
“``(3) Items to be included.--In developing the Formulary, the Secretary shall rely on the best available evidence to identify which items and services should be included on the Formulary. ``(c) Publication and Communication.-- ``(1) Publication and update.--The Secretary shall publish the Formulary on a website of the Department and shall update the Formulary periodically. ``(2) Communication.--The Secretary shall communicate to veterans the contents of the Formulary and information about how to appeal decisions regarding the provision of items and services on the Formulary. ``(d) Contracts.--The Secretary shall enter into such contracts as the Secretary considers necessary to support the availability of items and services included in the Formulary.”
“Prosthetic and Rehabilitative Items and Services Formulary ``(a) In General.--The Secretary shall establish a list of prosthetic and rehabilitative items and services, which may be referred to as the `Prosthetic and Rehabilitative Items and Services Formulary' or the `Formulary', for purposes of furnishing medical services under section 1701(6)(F) of this title pursuant to section 1710 of this title. ``(b) Requirements.-- ``(1) Input.--In developing the Formulary, the Secretary shall solicit input from veterans and the public. [[Page H4573]] ``(2) Availability of items.--The Secretary shall ensure that all items and services included in the Formulary are available at or through all facilities of the Department.”
“(B) Incorporation of measures.--Definitions included under subparagraph (A) with respect to identifying social determinants of health needs shall incorporate measures for quantifying the relative severity of any such social determinant of health need identified in an individual. SEC. 316. IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS PROSTHETIC AND REHABILITATIVE ITEMS AND SERVICE. (a) Prosthetic and Rehabilitative Items and Services Formulary.-- (1) In general.--Chapter 17 of title 38, United States Code, is amended by inserting after section 1709C the following new section: ``Sec. 1709D.”
“(b) Collection of Information From Veterans Related to Social Determinants of Health.-- (1) In general.--The Secretary of Veterans Affairs shall collect from 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, as part of routine screenings of such veterans under the laws administered by the Secretary, information related to social determinants that may factor into the health of such veterans. (2) Social determinants of health.-- (A) In general.--The information collected under paragraph (1) shall include standardized definitions for identifying social determinants of health needs identified in the ICD-10 diagnostic codes Z55 through Z63 and Z75 (as in effect on the date of enactment of this Act).”
“(xii) Transition assistance for veterans newly separated or discharged from active military, naval, air, or space service (as defined in section 101(24) of title 38, United States Code). (xiii) Assistance with utilities necessary for safe habitation. (xiv) Other services directly related to health care access, suicide prevention, homelessness prevention, food insecurity, transportation to health care, or assistance separating from military service and reentering civilian life, as expressly authorized under laws administered by the Secretary. (E) Secretary.--The term ``Secretary'' means the Secretary of Veterans Affairs. (F) State.--The term ``State'' has the meaning given that term in section 101 of title 38, United States Code.”
“(iv) A State, local, territorial, or Tribal health or social services agency. (v) A State public housing authority or housing finance agency. (vi) A public health information exchange or public health information network, as defined by the Secretary. (vii) A faith-based service provider. (viii) Any other similar entity, as determined by the Secretary. (D) Covered services.--The term ``covered services'' means any of the following: (i) Nutritional assistance. (ii) Housing. (iii) Health care, including preventive health intervention, chronic disease management, and behavioral health care. (iv) Transportation. (v) Job training and employment. (vi) Child development or care. (vii) Caregiving and respite care. (viii) Disability assistance. (ix) Suicide prevention. (x) Sexual assault services. (xi) Legal aid.”
“(B) Community integration platform.--The term ``community integration platform'' means an interoperable platform or network of interoperable systems used to enable the coordination, alignment, and connection of covered entities and veterans at the local level for purposes of communication, service coordination, and referral management of covered services. (C) Covered entity.--The term ``covered entity'' means any of the following entities or providers that have entered into an agreement with the Secretary to participate in the pilot program: (i) A community-based organization that-- (I) accepts referrals from health care organizations; and (II) provides covered services. (ii) A public or private health care provider organization. (iii) A public or private funded payor of health care services, including home- or community-based services.”
“(11) Limitations.--(A) The Secretary may not use the pilot program established under subsection (a) to supplant services otherwise required to be furnished by the Department under title 38, United States Code. (B) No covered entity participating in the pilot program established under subsection (a) may receive access to personally identifiable information, protected health information, or social determinants information of a veteran without the veteran's informed written consent, and such information may be used only for the specific referral or service authorized by the veteran. (12) Definitions.--In this subsection: (A) 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.”
“(B) Report and recommendations.-- (i) In general.--Not later than four years after the commencement of the pilot program, the Comptroller General shall-- (I) submit to Congress a report on the evaluation conducted under subparagraph (A); (II) make such report publicly available; and (III) based on such evaluation, make recommendations to the Secretary on how to improve and sustain the community integration platform established or enhanced under the pilot program. (ii) Elements of report.--The report under clause (i)(I) shall include data on-- (I) what covered services under the pilot program are being utilized the most; (II) what requests for services under the pilot program cannot be met; and (III) the impact of the provision of services under the pilot program on health outcomes of veterans.”
“(10) Comptroller general evaluation, report, and recommendations.-- (A) Evaluation.--The Comptroller General of the United States shall conduct an evaluation that measures the overall impact of the community integration platform established or enhanced under the pilot program with respect to-- (i) changes in individual and population health outcomes among veterans; (ii) changes in access to health care or social services among veterans; and (iii) such other factors as the Comptroller General considers appropriate.”
“(B) Briefing on entities not selected.--Not later than 180 days after the commencement of the pilot program, and not less frequently than once every 180 days thereafter until the conclusion of the pilot program, the Secretary shall brief the appropriate committees of Congress on the covered entities that submitted an application to participate in the pilot program but were not selected for participation and the reason those entities were not selected.”
“(9) Report and briefings.-- (A) Report.--Not later than three years after the commencement of the pilot program, the Secretary shall submit to the appropriate committees of Congress a report analyzing the needs of veterans for covered services reflected by the use of such services under the community integration platform under the pilot program, including an assessment of-- (i) the need for such services that is being met through such platform; and (ii) the need for such services that is not being met through such platform.”
“(7) Coordination and integration of programs.-- (A) Coordination with existing networks.--In carrying out the pilot program, the Secretary shall coordinate with existing community networks. (B) Coordination and integration with state medicaid programs.--The Secretary may consult and coordinate with the Secretary of Health and Human Services and with States regarding existing Federal and State programs, but nothing in this section shall be construed to authorize the Secretary of Veterans Affairs to administer, direct, or modify a State Medicaid program or waiver. (8) Performance benchmarks.--The Secretary shall establish performance benchmarks for the pilot program, including measures of referral completion, timeliness of service connection, and veteran-reported satisfaction.”
“(C) Tracking of information.-- (i) In general.--The Secretary shall track-- (I) the number of referrals of veterans to covered entities through the community integration platform under the pilot program; (II) the response time of covered entities to which such veterans are referred; and (III) the outcome of the initial meeting by a veteran and a covered entity to which the veteran is referred, including a description of the services that are provided to the veteran by such entity. (ii) Tracking by entities.--The Secretary may require covered entities participating in the pilot program to track the information required under clause (i) in a medium determined appropriate by the Secretary.”
“(6) Screening and tracking of participants.-- (A) In general.--The Secretary shall require veterans participating in the community integration platform under the pilot program to provide information regarding social determinants of health using the ICD-10 diagnostic codes Z55 through Z63 and Z75 (as in effect on the date of the enactment of this Act) in a standardized risk assessment or screening tool and such other information as the Secretary considers necessary to administer the pilot program. (B) Informed consent.--Information collected under the pilot program with respect to a veteran shall be obtained with the informed consent of the veteran and used solely for purposes of care coordination, service delivery, or program evaluation under the pilot program.”
“(B) Review.-- (i) In general.--The Secretary shall review the applications of covered entities submitted under subparagraph (A) to ensure that the participation of such entities would be safe and appropriate for veterans participating in the pilot program. (ii) Due diligence.--In reviewing applications under clause (i), the Secretary shall conduct due diligence consistent with how [[Page H4572]] the Secretary conducts due diligence for public-private partnerships under other laws administered by the Secretary.”
“In procuring technology under this section, the Secretary may prioritize, to the maximum extent practicable, technologies, platforms, or capabilities that are already deployed, validated, interoperable, or otherwise in operational use within medical centers or other components of the Department, unless the Secretary determines and documents that an alternative solution would better achieve the purposes of this section. (5) Application process.-- (A) In general.--The Secretary may require covered entities that seek to participate in the pilot program to submit to the Secretary an application therefore in such form, in such manner, and containing such commitments and information as the Secretary considers necessary to carry out this section.”
“(C) Variety of facilities.--In selecting facilities under subparagraph (A), the Secretary shall ensure the selection of a variety of different types of facilities, including-- (i) frontier facilities; (ii) under-resourced facilities; (iii) facilities at which there are existing efforts to coordinate with community resources; and (iv) facilities located in communities with an established community-based veteran service coordination network capable of integration with the pilot program. (4) Procurement of technology.--In carrying out the pilot program, the Secretary shall ensure full and open competition in the procurement of any services or technology and shall not enter into an exclusive national contract for the operation of the community integration platform under the pilot program.”
“(3) Locations.-- (A) Initial locations.--The Secretary shall carry out the pilot program at not fewer than five medical facilities of the Department of Veterans Affairs selected by the Secretary for purposes of the pilot program. (B) Expansion.--The Secretary may expand beyond initial sites for the pilot program selected under paragraph (1) not before two years after the date of enactment, not before thirty days after briefing the Committees on Veterans' Affairs of the Senate and the House of the expansion plan, and after demonstrated success.”
“300jj-14), for the provision of covered services; (E) ensures that-- (i) reasonable measures are taken to promote connectivity and interoperable exchange among covered entities and between covered entities and veterans; and (ii) appropriate privacy and security protections are in place, in accordance with applicable Federal and State privacy law; (F) is accessible by employees of the Department, covered entities, and veterans; (G) connects covered entities and veterans for purposes of communication, service coordination, and consumer assistance, referral and capacity management, outcome tracking and reporting, and related services; and (H) is accessible via a web-based platform for all veterans and via a non-web-based alternative platform or process for veterans who are unable to easily and reliably access the web-based platform.”
“(2) Elements of pilot program.--In carrying out the pilot program, the Secretary shall ensure that the community integration platform established or enhanced under the pilot program-- (A) permits veterans to identify and connect with covered entities that furnish covered services; (B) permits covered entities to identify and connect with veterans in need of covered services; (C) utilizes, to the extent practicable, existing interoperable technology networks; (D) prioritizes connectivity with appropriate existing technology networks developed by public or private organizations that comply with, as applicable, standards adopted by the Secretary of Health and Human Services under section 3004 of the Public Health Service Act (42 U.S.C.”
“(a) Pilot Program on Establishment or Enhancement of Community Integration Platform for Veterans.-- (1) In general.--Commencing not later than 18 months after the date of the enactment of this Act, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment of the Department of Veterans Affairs, shall carry out a pilot program under which the Secretary shall establish a new, or enhance an existing, interoperable community integration platform to coordinate local support services for veterans through other governmental and nongovernmental organizations (in this section referred to as the ``pilot program'').”
“(3) Critical access hospital defined.--In this section, the term ``critical access hospital'' has the meaning given that term in section 1861(mm) of the Social Security Act (42 U.S.C. 1395x(mm)). SEC. 315. PILOT PLATFORM FOR SERVICES FOR VETERANS; COLLECTION FROM VETERANS OF INFORMATION RELATED TO SOCIAL DETERMINANTS OF HEALTH.”
“(2) Outreach to providers.--Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, through the Office of Rural Health (or successor office) and the Office of Integrated Veteran Care (or successor office), shall-- (A) conduct outreach to health care facilities and critical access hospitals in rural areas regarding-- (i) the Veterans Community Care program under section 1703 of title 38, United States Code, and the pilot program under subsection (a) of this section; and (ii) any other matters the Secretary considers appropriate; and (B) seek to enter into contracts, partnerships, agreements, or other arrangements with health care facilities and critical access hospitals in rural areas.”
“(c) Outreach.-- (1) Outreach to veterans.--Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, through the Office of Rural Health (or successor office) and the Office of Integrated Veteran Care (or successor office), shall conduct outreach to veterans residing in rural, highly rural, and frontier areas regarding-- (A) opportunities to seek care through facilities and programs of the Department of Veterans Affairs, including via telehealth, existing programs provided through grantees or contractors of the Department, Vet Centers (as defined in section 1712A of title 38, United States Code), and volunteer programs and services for transportation; (B) opportunities to seek care though the Veterans Community Care Program under section 1703 of title 38, United States Code; (C) opportunities to seek care at critical access hospitals with contracts, partnerships, or agreements with the Department of Veterans Affairs; and (D) any other matters the Secretary considers appropriate.”
“(3) Implementation.--Not later than 90 days after submitting the action plan under paragraph (1), the Secretary shall begin implementation of the plan and shall ensure full implementation not later than two years after the date of the enactment of this Act.”
“(2) Elements.--In developing the action plan required under paragraph (1), the Secretary shall-- (A) consult with health care providers that provide care in the community under the laws administered by the Secretary, State Offices of Rural Health, Tribal health authorities, and other relevant stakeholders in rural, highly rural, and frontier areas as the Secretary determines appropriate; (B) assess barriers to care in the community for veterans residing in rural and highly rural areas, including challenges with respect to-- (i) network adequacy; (ii) provider participation; (iii) geographic distance; (iv) transportation; (v) information technology; (vi) physical infrastructure; (vii) outreach and understanding of eligibility for such care; (viii) timeliness of referrals, authorization, and medical documentation exchange; and (ix) any other matter the Secretary determines appropriate; (C) list specific and measurable strategies and actions to address the barriers and challenges assessed under subparagraph (B), to include the consideration of-- (i) expanding participation in the Veterans Community Care Program under section 1703 of title 38, United States Code, among providers in rural, highly rural, and frontier areas; (ii) physically locating health care facilities of the Department of Veterans Affairs within the same building or on the campuses of other health care facilities located in rural, highly rural, or frontier areas; (iii) enhancing transportation assistance; (iv) increasing reimbursement rates, including through cost-based reimbursements; and (v) improving coordination with State, Tribal, and local partners; and (D) assess legislative and regulatory barriers, if any, to addressing the barriers assessed under subparagraph (B).”
“(b) Action Plan to Address Barriers to Care for Veterans Living in Rural Areas.-- (1) In general.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop and submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a comprehensive action plan to identify, address, and eliminate barriers to accessing care for veterans residing in rural, highly rural, and frontier areas.”
“(9) Definitions.--In this subsection: (A) Critical access hospital.--The term ``critical access hospital'' has the meaning [[Page H4571]] given that term in section 1861(mm) of the Social Security Act (42 U.S.C. 1395x(mm)). (B) Eligible veteran.--The term ``eligible veteran'' means a veteran-- (i) enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code; (ii) who has received care at a facility of the Department or in-network provider under the Veterans Community Care Program under section 1703 of such title during the previous two-year period; (iii) who lives within 35 miles of a critical access hospital; and (iv) who would be eligible for care or services under the Veterans Community Care Program.”
“(iii) Subsequent reports.--Each report required under clause (i) after the initial report shall contain-- (I) an updated list of facilities participating in the pilot program; (II) the number of veterans participating in the pilot program, disaggregated by facility; (III) an overview of the types of care received through the pilot program; (IV) feedback from the facilities participating in the pilot program, with identifying information removed, regarding the status of the pilot program, challenges in participating in the pilot program, and the interest of the facility in continued participation in such a program; and (V) any additional information that the Secretary determines relevant or necessary.”
“(ii) Initial report.--The initial report required under clause (i) shall contain-- (I) a description of the outreach conducted to critical access hospitals concerning the pilot program; (II) a list of facilities that have opted to participate in the pilot program; (III) information, by facility, regarding total obligations and expenditures, utilization, average time from authorization to care, timeliness regarding medical records return and claim payment, emergency department utilization, veteran satisfaction, and any effect on care furnished by Department facilities; and (IV) a list of the barriers, if any, cited by facilities that opted not to participate in the pilot program.”
“(7) Limitation.--The Secretary may not extend the pilot program beyond the five-year period specified under subsection (a) or expand the pilot program to additional States or convert the pilot program into a permanent authority unless expressly authorized by a subsequent Act of Congress. (8) Report.-- (A) In general.--Not later than one year after the date of the enactment of this Act, and annually thereafter for the duration of the pilot program, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans Affairs of the House of Representatives a report on the pilot program. (B) Elements.-- (i) In general.--Each report required under subparagraph (A) shall contain the recommendation of the Secretary for the expansion or continuation of the pilot program.”
“(B) Hospitals.--The Secretary shall conduct direct outreach to critical access hospitals in areas in which the pilot program is carried out to notify those hospitals of their ability to participate in the pilot program. (6) Staff.--The Secretary shall ensure that each medical facility of the Department within the catchment area of a location in which the pilot program is carried out has sufficient dedicated staff to handle-- (A) administrative and technical challenges that arise from the pilot program; (B) care coordination and follow up with the veteran and the facility participating in the pilot program after an episode of care; and (C) timely records return following an episode of care.”
“(3) Locations.--The Secretary shall ensure participation in the pilot program is open to all qualified facilities located in States that are designated by the Centers for Medicare & Medicaid Services as frontier States. (4) Authorization for care.--The Secretary shall provide eligible veterans opting to participate in the pilot program a one-year authorization from the Department to receive outpatient services at facilities participating in the pilot program. (5) Outreach.-- (A) Eligible veterans.--Not less frequently than annually during each year in which the pilot program is carried out, the Secretary shall conduct direct outreach to eligible veterans in areas in which the pilot program is carried out to notify such veterans of their ability to participate in the pilot program.”
“(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 to participants in the pilot program, including through timely sharing of pertinent medical record and other information between medical facilities participating in the pilot program and medical facilities of the Department of Veterans Affairs; (ii) the provision of health care services through the pilot program is in accordance with the medical benefits package of the Department; (iii) no additional charges are imposed on veterans participating in the pilot program or the health care insurer of such veterans for any medical service for which payment is made by the Secretary; (iv) appropriate reimbursement rates, including through the consideration of cost-based reimbursements; and (v) such other considerations as the Secretary considers appropriate.”
“(2) Contracts, agreements, or other arrangements.-- (A) In general.--In carrying out the pilot program, the Secretary shall enter into contracts, agreements, or other arrangements with facilities participating in the pilot program to reimburse critical access hospitals and affiliated clinics for outpatient health care and medical services provided to eligible veterans.”
“EXPANSION OF ACCESS BY VETERANS TO CRITICAL ACCESS HOSPITALS AND AFFILIATED CLINICS UNDER THE VETERANS COMMUNITY CARE PROGRAM. (a) Pilot Program to Improve Care Coordination for Veterans From Critical Access Hospitals and Affiliated Clinics.-- (1) In general.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence a five-year pilot program to improve care coordination for eligible veterans who receive care from a critical access hospital or a provider-based rural health clinic affiliated with such hospital (in this section referred to as the ``pilot program'').”
“(B) Elements.--Each report required under subparagraph (A) shall include, with respect to the year preceding the date of the report, the following elements: (i) The percentage of cases in which a physician, nurse practitioner, or physician assistant employed by the Secretary complied with paragraph (1)(A). (ii) The number of cases in which such a physician, nurse practitioner, or physician assistant could not so comply. (iii) An identification of the most common reasons why such a physician, nurse practitioner, or physician assistant could not so comply. (3) Rule of construction.--Nothing in this section shall be construed to authorize a physician assistant or nurse practitioner to certify a death in any State in which such authority is not permitted under State or local law. SEC. 314.”