Sponsors (14)
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Amends 38 U.S.C. 1703E to (a) change the location of the Center for Innovation for Care and Payment from "within the Department" to "within the Office of the Secretary," (b) convert a discretionary provision from "may" to a mandatory "shall," (c) add an explicit mission to increase productivity, efficiency, and modernization throughout the Department, (d) require a specific budgetary line item identifying amounts required to carry out the section in the Department's budget justification materials submitted to Congress, (e) expand references to applicable rules and documents and modify waiver language to refer to "waiving any provision of this title," (f) add multiple Department offices to the list of participants/consulted entities, (g) expand the types of representatives that may be included to expressly include nonprofit organizations and other public and private sector entities with clinical and analytical expertise, and (h) add a new annual reporting requirement on Center activities, staff, budget, resources, and outcomes (new subsection (k)).
Replaces subsections (a) through (e) with new subsection (a) establishing explicit eligibility access standards (driving time and wait time thresholds for primary/mental/extended care and specialty care), excludes telehealth availability from eligibility determinations, requires documentation when a veteran agrees to longer drive/wait times, requires calculating wait time from original request if an appointment was canceled by the Department, and establishes triennial review and reporting requirements; also strikes subsection (g), redesignates subsections (f), (h), and (i) as (d), (e), and (f), and makes related conforming edits.
Amends paragraph (1)(D) and paragraph (3) to replace references to 'designated access standards developed by the Secretary under section 1703B' with 'eligibility access standards under section 1703B(a)'.
Adds new paragraph (5) requiring the Secretary to notify each covered veteran in writing of the veteran's eligibility for care or services as soon as possible, but not later than two business days after the Secretary is aware the veteran is seeking care and is eligible; requires periodic reminders of ongoing eligibility as determined by the Secretary; allows notifications to be provided electronically.
Adds new subparagraphs (F), (G), and (H) to require consideration of (F) the covered veteran's preference for where/when/how to seek care, (G) continuity of care, and (H) whether the veteran requests or requires assistance of a caregiver or attendant.
Redesignates existing subsection (o) as (p); inserts new subsection (o) requiring written notification of denials of requests for care within two business days with reasons and instructions for appeal via the VHA clinical appeals process (including explanation when denial is due to not meeting the eligibility access standards); inserts new subsection (p) requiring discussion of telehealth options when discussing care options if telehealth is available, appropriate, and acceptable to the veteran; redesignates prior subsection (p) as (q).
Amends subsection (b) by striking '180 days' and inserting 'one year' for the deadline to submit claims by health care entities and providers under the prompt payment standard.
Makes changes to how the VA delivers and manages community and specialty care so veterans get care faster and with clearer notice. It sets concrete drive‑time and wait‑time standards for community care eligibility, requires quicker written notices for eligibility determinations and denials, extends a claims filing deadline, and adds telehealth and caregiver considerations. Strengthens VA residential mental‑health and substance‑use programs by setting screening/admission timeframes, tracking bed availability and wait times, requiring care coordination and staff training, and directing GAO review. Also directs VA to build online tools, run a multi‑site outpatient mental‑health/substance‑use pilot, reform the Center for Innovation for Care and Payment, and produce recurring reports and plans for oversight and budget transparency.
Establishes eligibility access standards in 38 U.S.C. §1703B(a) so a covered veteran may elect community care when VA cannot schedule needed care meeting these standards: for primary care, mental health, or extended care (excluding nursing home care) — average driving time within 30 minutes and appointment within 20 days (unless veteran agrees to a longer drive time or later date); for specialty care — average driving time within 60 minutes and appointment within 28 days (unless veteran agrees otherwise).
Specifies that telehealth appointments provided by the Department shall NOT be counted when determining whether the Department meets the eligibility access standards in 38 U.S.C. §1703B(a).
When a VA-cancelled appointment (cancelled by VA for reasons other than the veteran’s request) leads to calculating wait time for a subsequent appointment, the wait time is calculated from the date of the request for the original, canceled appointment.
If a veteran agrees to a longer drive time or a later appointment date, the Secretary must document that agreement in the veteran’s electronic health record and provide the veteran a copy (which may be electronic).
Require that the eligibility access standards apply to all care and services in the Department’s medical benefits package for which a covered veteran is eligible under 38 U.S.C. §1703 (excluding nursing home care) and apply to all covered veterans, whether new or established patients.
Primary effects: Veterans should experience faster, clearer access to community and residential mental‑health/substance‑use services because of set drive‑time/wait‑time triggers, required quick written notifications, and enhanced telehealth/caregiver accommodations. VA clinical staff and medical centers will face new operational duties—shorter screening/admission deadlines, bed‑availability tracking, staff training, care‑coordination tasks, and additional reporting. Community providers who contract with VA may see increased referrals and must coordinate more closely with VA systems. The law also requires VA to build online tools and run pilots, which will shift some workload to program, IT, and budget offices and create new data/reporting flows for oversight. Oversight agencies (GAO, congressional committees) will receive new reporting and review material to monitor access and outcomes. Overall, the bill increases administrative and compliance work for VA and partner providers while aiming to reduce veteran wait times and improve transparency; costs, staffing, and implementation logistics at VA will determine how quickly veterans see benefit.
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Read twice and referred to the Committee on Veterans' Affairs.
Introduced January 28, 2025 by Jerry Moran · Last progress January 28, 2025
Committee on Veterans' Affairs. Ordered to be reported with an amendment in the nature of a substitute favorably.
Committee on Veterans' Affairs. Hearings held.
Read twice and referred to the Committee on Veterans' Affairs.
Introduced in Senate
