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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“``(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.”
“``(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).”
“``(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.”
“``(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.”
“``(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.”
“``(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) 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.”
“``(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.”
“``(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.”
“``(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.”
“``(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.”
“``(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.”
“``(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.”
“``(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 [[Page H4593]] ``(B) accepted into a covered treatment program but is not offered bed placement in a timely manner.”
“``(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.”
“``(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.”
“``(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.”
“``(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 of Representatives a report describing the consultation and oversight processes required by this subsection.”
“``(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 assessed pursuant to a subsequent clinical screening under subsection (g)(3)(F); ``(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.”
“``(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 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.”
“Improvements to Department of Veterans Affairs mental health residential rehabilitation treatment program ``(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.”
“``(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.”