S 141 — Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act

[[Page 138 STAT.

2711]] SEC.

``(B) The<<NOTE: Secretary shall ensure that the standards for quality established under paragraph (1) are comparable to industry standards to ensure there is adequate data transference between care furnished by the Department and care furnished by a non-Department provider.'';

Data.>> The Secretary shall ensure that the standards for quality established under paragraph (1) are comparable to industry standards to ensure there is adequate data transference between care furnished by the Department and care furnished by a non-Department provider.'';

and (ii) by striking ``and other nongovernmental entities'' and inserting ``and other non-governmentalnon- governmental entities including Third Party Administrators'';

``(5) When<<NOTE: collecting, considering, and applying data related to patient care for purposes of establishing standards for quality under paragraph (1), the Secretary shall ensure no metric is being over or under analyzed.

``(6)Data.>> InWhen collecting, considering, and applying data related to patient care for purposes of establishing standards for quality under paragraph (1), the Secretary shall--shall ``(A)ensure utilizeno themetric mostis up-to-datebeing practicesover foror extractingunder andanalyzed. analyzing relevant data;

``(6) <<NOTE:

Data.>> In establishing standards for quality under paragraph (1), the Secretary shall-- ``(A) utilize the most up-to-date practices for extracting and analyzing relevant data;

``(7)(A) Not<<NOTE: less frequently than once every five years, the Secretary shall update the standards for quality established under paragraph (1) pursuant to the requirements for the establishment of such standards under this subsection.

``(B)Time Notperiod. later than 30 days after any date on which the Secretary updates, pursuant to subparagraph (A), the standards for quality under paragraph (1), the Secretary shall submit to the appropriate committees of Congress a report on such updated standards for quality.'';

andUpdates.>> (2)Not inless subsectionfrequently (b)-- (A) in paragraph (1)-- (i) by striking ``Not later than 1once yearevery afterfive years, the dateSecretary onshall whichupdate the Secretary establishes standards for quality established under subsectionparagraph (a)''(1) andpursuant insertingto ``Notthe lessrequirements frequentlyfor thanthe onceestablishment everyof threesuch years'';standards under this subsection.

``(B) <<NOTE:

Reports.>> Not later than 30 days after any date on which the Secretary updates, pursuant to subparagraph (A), the standards for quality under paragraph (1), the Secretary shall submit to the appropriate committees of Congress a report on such updated standards for quality.'';

and (2) in subsection (b)-- (A) in paragraph (1)-- (i) by striking ``Not later than 1 year after the date on which the Secretary establishes standards for [[Page 138 STAT.

2712]] quality under subsection (a)'' and inserting ``Not less frequently than once every three years'';

(b) Deadline<<NOTE: for Update.--The Secretary, pursuant to paragraph (7) of section 1703C(a) of title 38, United States Code (as added by subsection (a)), shall make the first update to the standards for quality established under paragraph (1) of such section not later than the date that is five years after the date on which the Secretary submits the report under paragraph (2) of subsection (d).

38 USC 1703C note.>> Deadline for Update.--The Secretary, pursuant to paragraph (7) of section 1703C(a) of title 38, United States Code (as added by subsection (a)), shall make the first update to the standards for quality established under paragraph (1) of such section not later than the date that is five years after the date on which the Secretary submits the report under paragraph (2) of subsection (d).

(d) Updates<<NOTE: to Quality Care Metrics.-- (1) Initial report.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on how the Secretary plans to implement the amendments made by subsections (a).

38 USC 1703C note.>> Updates to Quality Care Metrics.-- (1) Initial report.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report on how the Secretary plans to implement the amendments made by subsections (a).

(e) Audit of Quality Care Metrics.-- (1) In<<NOTE: general.--Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into one or more contracts with a non-Department entity described in paragraph (2) to conduct an audit on the quality of care from the Department of Veterans Affairs, including through non-Department health care providers pursuant to section 1703 of title 38 United States Code.

Deadline.

Contracts.>> In general.--Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into one or more contracts with a non-Department entity described in paragraph (2) to conduct an audit on the quality of care from the Department of Veterans Affairs, including through non-Department health care providers pursuant to section 1703 of title 38 United States Code.

and (B)[[Page has138 experienceSTAT. and proven outcomes in optimizing the accuracy and comprehensiveness of data collection and analysis related to the quality of health care services.

(3)2713]] Elements.--The(B) audithas requiredexperience underand paragraphproven (1)outcomes shallin includeoptimizing the following:accuracy and comprehensiveness of data collection and analysis related to the quality of health care services.

(3) <<NOTE:

Assessments.>> Elements.--The audit required under paragraph (1) shall include the following:

(D) Any<<NOTE: recommendations of such private sector entity with respect to improvements that the Secretary could administer to more accurately capture the quality of care furnished by the Department.

Recommenda- tions.>> Any recommendations of such private sector entity with respect to improvements that the Secretary could administer to more accurately capture the quality of care furnished by the Department.

(f) Appropriate<<NOTE: Committees of Congress Defined.--In this section, the term ``appropriate committees of Congress'' has the meaning given such term in section 1703C of title 38, United States Code.

38 USC 1703C note.>> Appropriate Committees of Congress Defined.--In this section, the term ``appropriate committees of Congress'' has the meaning given such term in section 1703C of title 38, United States Code.

PILOT<<NOTE: PROGRAM TO IMPROVE ADMINISTRATION OF CARE UNDER VETERANS COMMUNITY CARE PROGRAM.

(a)38 Establishment.--PursuantUSC to1703 sectionnote.>> 1703EPILOT ofPROGRAM titleTO 38,IMPROVE UnitedADMINISTRATION StatesOF Code,CARE theUNDER SecretaryVETERANS ofCOMMUNITY VeteransCARE Affairs,PROGRAM. acting through the Center for Innovation for Care and Payment established under such section, shall carry out a pilot program to seek to develop and implement a plan-- (1) to provide monetary and non-monetary incentives to a covered health care provider-- (A) to allow the Secretary to see the scheduling system of the provider, to assess the availability of, and to assist in scheduling appointments for, veterans under the Veterans Community Care Program under section of such title, including through synchronous, asynchronous, and asynchronous assisted digital scheduling;

(a) <<NOTE:

Plan.>> Establishment.--Pursuant to section 1703E of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under such section, shall carry out a pilot program to seek to develop and implement a plan-- [[Page 138 STAT.

2714]] (1) to provide monetary and non-monetary incentives to a covered health care provider-- (A) <<NOTE:

Assessment.>> to allow the Secretary to see the scheduling system of the provider, to assess the availability of, and to assist in scheduling appointments for, veterans under the Veterans Community Care Program under section 1703 of such title, including through synchronous, asynchronous, and asynchronous assisted digital scheduling;

(b) Report.--Not later than one year after the date of the establishment of the pilot program under this section, and annually thereafter during the term of the pilot program, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report on the pilot program that includes, with respect to the period covered by the report-- (1) an<<NOTE: assessment of the extent to which-- (A) the system of the Department of Veterans Affairs for scheduling appointments for veterans under the Veterans Community Care Program has improved;

Assessment.>> an assessment of the extent to which-- (A) the system of the Department of Veterans Affairs for scheduling appointments for veterans under the Veterans Community Care Program has improved;

(2) a<<NOTE: list of the continuing professional educational training courses under subparagraph (B) of such subsection available to covered health care providers;

List.>> a list of the continuing professional educational training courses under subparagraph (B) of such subsection available to covered health care providers;

(1) The term ``covered health care provider'' means a health care provider-- (A)[[Page described138 inSTAT. subsection (c) of section 1703 of title 38, United States Code, that furnishes care or services under the Veterans Community Care Program pursuant to a contract or agreement with a Third Party Administrator;

2715]] (A) described in subsection (c) of section 1703 of title 38, United States Code, that furnishes care or services under the Veterans Community Care Program pursuant to a contract or agreement with a Third Party Administrator;

(4) The term ``VHA TRAIN program'' means the free program of the Veterans Health Administration that offers veteran-veteran-specific specific continuing medical education courses.

PILOT<<NOTE: PROGRAM ON CONSOLIDATING APPROVAL PROCESS OF DEPARTMENT OF VETERANS AFFAIRS FOR COVERED DENTAL CARE.

(a)38 InUSC General.--Not1703 laternote.>> thanPILOT 180PROGRAM daysON afterCONSOLIDATING theAPPROVAL datePROCESS ofOF theDEPARTMENT enactmentOF ofVETERANS thisAFFAIRS Act,FOR theCOVERED SecretaryDENTAL ofCARE. Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall carry out a pilot program under which the Secretary shall hire-- (1) general dentists at medical facilities of the Department of Veterans Affairs to manage approval by the Department of treatment plans requested by dental providers in providing covered dental care;

(a) <<NOTE:

Deadline.>> In General.--Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall carry out a pilot program under which the Secretary shall hire-- (1) general dentists at medical facilities of the Department of Veterans Affairs to manage approval by the Department of treatment plans requested by dental providers in providing covered dental care;

(D) an<<NOTE: assessment of the efficacy of hiring general dentists and dental specialists pursuant to such pilot program;

(E)Assessment.>> aggregatedan feedbackassessment withof respectthe toefficacy suchof pilothiring programgeneral from dentists ofand thedental Departmentspecialists inpursuant Veteransto Integrated Service Networks participating in such pilot program;

(E) aggregated feedback with respect to such pilot program from dentists of the Department in Veterans [[Page 138 STAT.

2716]] Integrated Service Networks participating in such pilot program;

(B) includes<<NOTE: recommendations of the Secretary on whether the pilot program should be-- (i) extended;

Recommenda- tions.>> includes recommendations of the Secretary on whether the pilot program should be-- (i) extended;

STRATEGIC<<NOTE: PLAN ON VALUE-BASED HEALTH CARE SYSTEM FOR VETERANS HEALTH ADMINISTRATION;

38 USC 1701 note.>> STRATEGIC PLAN ON VALUE- BASED HEALTH CARE SYSTEM FOR VETERANS HEALTH ADMINISTRATION;

(a) Establishment of Working Group.-- (1) In<<NOTE: general.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall-- (A) establish a working group on value-based care;

Deadline.>> In general.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall-- (A) establish a working group on value-based care;

(v)[[Page The138 DirectorSTAT. of the Office of Connected Care of the Department (or any successor office).

2717]] (v) The Director of the Office of Connected Care of the Department (or any successor office).

(B) Optional<<NOTE: members.--The Secretary of Veterans Affairs may appoint any of the following individuals as members of the working group:

Appointments.>> Optional members.--The Secretary of Veterans Affairs may appoint any of the following individuals as members of the working group:

(1) An<<NOTE: identification of the state of the Veterans Health Administration as of the date of the enactment of this Act, including an assessment of the current model of health care delivery used by the Veterans Health Administration in medical facilities of the Department of Veterans Affairs.

(2)Assessment.>> An assessmentidentification of the capacitystate needs of the Veterans Health Administration duringas of the five-yeardate periodof beginningthe onenactment of this Act, including an assessment of the datecurrent model of health care delivery used by the enactmentVeterans Health Administration in medical facilities of thisthe Act.Department of Veterans Affairs.

(3)[[Page An138 analysisSTAT. of the leadership of the Veterans Health Administration, including an assessment of leadership acumen and ability to implement a clear, shared vision and effective change management and care coordination.

2718]] (2) <<NOTE:

Assessment.

Time period.

Effective date.>> An assessment of the capacity needs of the Veterans Health Administration during the five-year period beginning on the date of the enactment of this Act.

(3) <<NOTE:

Analysis.

Assessment.>> An analysis of the leadership of the Veterans Health Administration, including an assessment of leadership acumen and ability to implement a clear, shared vision and effective change management and care coordination.

(6) An<<NOTE: analysis of value-based care models, including-- (A) a selection of potential models that would best work for the Veterans Health Administration;

Analysis.>> An analysis of value-based care models, including-- (A) a selection of potential models that would best work for the Veterans Health Administration;

and (C) a<<NOTE: thorough justification of the selection of each selected model, including a summary of the ability of such model to improve the metrics described under paragraph (9).

Summary.>> a thorough justification of the selection of each selected model, including a summary of the ability of such model to improve the metrics described under paragraph (9).

(10) With<<NOTE: respect to the system described in subparagraph (H), an analysis of variable value with respect to patient outcomes across different health care types and specialties.

(11)Analysis.>> AnWith assessmentrespect of--to (A)the previoussystem ordescribed ongoingin assessmentssubparagraph of(H), thean currentanalysis information technology infrastructure of thevariable Veteransvalue Healthwith Administration,respect including-- (i) such assessments conducted pursuant to thepatient Electronicoutcomes Healthacross Recorddifferent Modernizationhealth programcare oftypes theand Departmentspecialties. of Veterans Affairs;

(11) <<NOTE:

Assessment.>> An assessment of-- (A) previous or ongoing assessments of the current information technology infrastructure of the Veterans Health Administration, including-- (i) such assessments conducted pursuant to the Electronic Health Record Modernization program of the Department of Veterans Affairs;

(C) the<<NOTE: value-driven framework of the Department, in effect as of the date of the enactment of this Act, for evaluating health care innovations, and how improvements in such framework could be used to encourage innovation;

andEvaluation.>> (D)the workforcevalue-driven challengesframework and needs of the VeteransDepartment, Healthin Administrationeffect basedas on--of (i)the reviewsdate of workforcethe assessmentenactment dataof availablethis asAct, offor theevaluating datehealth ofcare theinnovations, enactmentand ofhow thisimprovements Act;[[Page 138 STAT.

2719]] in such framework could be used to encourage innovation;

and (D) workforce challenges and needs of the Veterans Health Administration based on-- (i) <<NOTE:

Reviews.>> reviews of workforce assessment data available as of the date of the enactment of this Act;

(II) the reports required by section 505 of the John S.

(III) the report required by section 301 of the VA Choice and Quality Employment Act of 2017 (Public Law 115-46);115- 46);

(12) Any<<NOTE: recommendations of the working group with respect to improving the information technology infrastructure described in clause (i) of subparagraph (J).

(13)Recommenda- Antions.>> analysisAny recommendations of how the value-drivenworking frameworkgroup describedwith inrespect clauseto (iii)improving ofthe suchinformation subparagraphtechnology couldinfrastructure bedescribed usedin toclause improve(i) the model of caresubparagraph delivery(J). by the Department.

(13) <<NOTE:

Analysis.>> An analysis of how the value-driven framework described in clause (iii) of such subparagraph could be used to improve the model of care delivery by the Department.

(c) Pilot Program.-- (1) In<<NOTE: general.--Not later than 180 days after the submission of the strategic plan pursuant to subsection (b), the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall commence a three- year pilot program under which the Secretary shall implement the elements of such strategic plan relating to the delivery, by the Veterans Health Administration, of primary care, inpatient and outpatient mental health treatment, inpatient and outpatient substance abuse treatment, spinal cord injury disorder care, and polytrauma care.

Deadline.

Time period.>> In general.--Not later than 180 days after the submission of the strategic plan pursuant to subsection (b), the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall commence a three-year pilot program under which the Secretary shall implement the elements of such strategic plan relating to the delivery, by the Veterans Health Administration, of primary care, inpatient and outpatient mental health treatment, inpatient and outpatient substance abuse treatment, spinal cord injury disorder care, and polytrauma care.

(C)[[Page A138 VeteransSTAT. Integrated Service Network that has a high rate of suicide among veterans.

2720]] (C) A Veterans Integrated Service Network that has a high rate of suicide among veterans.

PLAN<<NOTE: ON ADOPTION OF CERTAIN HEALTH INFORMATION STANDARDS FOR DEPARTMENT OF VETERANS AFFAIRS AND CERTAIN HEALTH CARE PROVIDERS.

38 USC note prec.

5701.>> PLAN ON ADOPTION OF CERTAIN HEALTH INFORMATION STANDARDS FOR DEPARTMENT OF VETERANS AFFAIRS AND CERTAIN HEALTH CARE PROVIDERS.

(b) Plan on Electronic Health Record Exchange.-- (1) In<<NOTE: general.--Not later than one year after the date of enactment of this Act, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a plan to provide, at no cost, to community care providers of the Department, through Third Party Administrators, a capability to facilitate the electronic direct exchange, between such providers and the Department, of-- (A) the health records of veterans;

Deadline.>> In general.--Not later than one year after the date of enactment of this Act, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a plan to provide, at no cost, to community care providers of the Department, through Third Party Administrators, a capability to facilitate the electronic direct exchange, between such providers and the Department, of-- [[Page 138 STAT.

2721]] (A) the health records of veterans;

and (B) a report that includes-- (i) an<<NOTE: analysis of gaps, if any, between the use, by the Department and other agencies, health information exchanges, and technology companies, of national health information interoperability standards and the potential, or optimal, use of such national health information interoperability standards;

(ii)Analysis.>> an analysis andof descriptiongaps, ofif any, between the participationuse, by the Department,Department community care providers, and other relevantagencies, entitieshealth ininformation theexchanges, Trusted Exchange Framework and Commontechnology Agreementcompanies, program of thenational Departmenthealth ofinformation Healthinteroperability standards and Humanthe Servicespotential, asor ofoptimal, theuse date of thesuch enactmentnational ofhealth thisinformation Act;interoperability standards;

(iii)(ii) recommendations<<NOTE: of the Secretary with respect to development of health information interoperability standards;

(iv)Analysis.>> timelinesan oranalysis schedulesand todescription implementof the planparticipation required by subsectionthe (a);Department, community care providers, and other relevant entities in the Trusted Exchange Framework and Common Agreement program of the Department of Health and Human Services as of the date of the enactment of this Act;

(iii) <<NOTE:

Recommenda- tions.>> recommendations of the Secretary with respect to development of health information interoperability standards;

(iv) <<NOTE:

Timelines.>> timelines or schedules to implement the plan required by subsection (a);

(B) Elements of subsequent reports.--Each report under subparagraph (A) submitted after the date on which the first report required by such subparagraph is submitted shall include a description of any revisions to-- (i)[[Page the138 planSTAT. required by subsection (a) made during the period covered by the report;

2722]] (i) the plan required by subsection (a) made during the period covered by the report;

(a) Report on Value-based Reimbursement Models.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, in consultation with the Center for Innovation for Care and Payment of the Department of Veterans Affairs under section 1703E of title 38 United States Code, the Office of Integrated Veteran Care of the Department, or successor office, and Third Party Administrators, shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report containing-- (1) an<<NOTE: assessment of the efforts of the Department pursuant to section 1703(i)(5) of such title, to incorporate value-based reimbursement models under the Veterans Community Care Program to promote the provision of high-quality care to veterans;

andAssessment.>> (2)an suchassessment recommendationsof forthe legislativeefforts orof administrativethe actionDepartment aspursuant theto Secretarysection considers1703(i)(5) appropriateof regardingsuch thetitle, useto ofincorporate value-based reimbursement models throughoutunder the Veterans Community Care Program underto sectionpromote 1703the provision of suchhigh-quality title.care to veterans;

and (2) <<NOTE:

Recommenda- tions.>> such recommendations for legislative or administrative action as the Secretary considers appropriate regarding the use of value-based reimbursement models throughout the Veterans Community Care Program under section 1703 of such title.

INSPECTOR<<NOTE: GENERAL ASSESSMENT OF IMPLEMENTATION OF VETERANS COMMUNITY CARE PROGRAM.

(a)38 InUSC General.--Not1703 laternote.>> thanINSPECTOR 18GENERAL monthsASSESSMENT afterOF theIMPLEMENTATION dateOF ofVETERANS theCOMMUNITY enactmentCARE ofPROGRAM. this Act, and periodically thereafter, the Inspector General shall assess the performance of the Department of Veterans Affairs in-- (1) appropriately identifying veterans eligible for care and services under section 1703 of title 38, United States Code;

(2)(a) informing<<NOTE: veterans of their eligibility for such care and services;

Deadline.

Time period.>> In General.--Not later than 18 months after the date of the enactment of this Act, and periodically thereafter, the Inspector General shall assess the performance of the Department of Veterans Affairs in-- (1) appropriately identifying veterans eligible for care and services under section 1703 of title 38, United States Code;

[[Page 138 STAT.

2723]] (2) informing veterans of their eligibility for such care and services;

(a) In<<NOTE: General.--Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on dental care furnished by the Secretary of Veterans Affairs under the Veterans Community Care Program under section 1703 of title 38, United States Code, that includes a review of-- (1) the impact current reimbursement rates provided by the Department of Veterans Affairs to dental providers under such program have on-- (A) the availability of dental care for veterans;

Review.>> In General.--Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on dental care furnished by the Secretary of Veterans Affairs under the Veterans Community Care Program under section 1703 of title 38, United States Code, that includes a review of-- (1) the impact current reimbursement rates provided by the Department of Veterans Affairs to dental providers under such program have on-- (A) the availability of dental care for veterans;

and (3) by<<NOTE: adding at the end the following new paragraph:

``(2)(A)Determination.>> Theby totaladding costat of providing services or in-kind assistance in the caseend of any veteran described in subparagraph (B) for any fiscal year under the programfollowing maynew exceedparagraph: 100 percent of the cost that would otherwise have been incurred as specified in paragraph (1) if the Secretary determines, based on a consideration of clinical need, geographic market factors, and such other matters as the Secretary may prescribe through regulation, that such higher total cost is in the best interest of the veteran.

``(2)(A) <<NOTE:

Regulations.>> The total cost of providing services or in-kind assistance in the case of any veteran described in subparagraph (B) for any fiscal year under the program may exceed 100 percent of the cost that would otherwise have been incurred as specified in paragraph (1) if the Secretary determines, based on a consideration of clinical need, geographic market factors, and such other matters as the [[Page 138 STAT.

2724]] Secretary may prescribe through regulation, that such higher total cost is in the best interest of the veteran.

(b) Applicability.--The<<NOTE: amendments made by subsection (a) shall apply with respect to fiscal years beginning on or after the date of the enactment of this Act.

Effective date.

38 USC 1720C note.>> Applicability.--The amendments made by subsection (a) shall apply with respect to fiscal years beginning on or after the date of the enactment of this Act.

``(f) In<<NOTE: furnishing services to a veteran under the program conducted pursuant to subsection (a), if a medical center of the Department through which such program is administered is located in a geographic area in which services are available to the veteran under a PACE program (as such term is defined in sections 1894(a)(2) and 1934(a)(2) of the Social Security Act (42 U.S.C.

Contracts.>> In furnishing services to a veteran under the program conducted pursuant to subsection (a), if a medical center of the Department through which such program is administered is located in a geographic area in which services are available to the veteran under a PACE program (as such term is defined in sections 1894(a)(2) and 1934(a)(2) of the Social Security Act (42 U.S.C.

1396u-1396u-4(a)(2))), 4(a)(2))), the Secretary shall seek to enter into an agreement with the PACE program operating in that area for the furnishing of such services.''.

Subchapter II of chapter 17 of title 38, United<<NOTE: States Code, is amended by adding at the end the following new section (and conforming the table of sections at the beginning of such chapter accordingly):

38 USC prec.

1701.>> United States Code, is amended by adding at the end the following new section (and conforming the table of sections at the beginning of such chapter accordingly):

Grants<<NOTE: or contracts to provide mental health support to family caregivers of veterans ``(a) Authority.--The Secretary may award grants or contracts to carry out, coordinate, improve, or otherwise enhance mental health counseling, treatment, or support to the family caregivers of veterans participating in the family caregiver program.

38 USC 1720K.>> Grants or contracts to provide mental health support to family caregivers of veterans ``(a) Authority.--The Secretary may award grants or contracts to carry out, coordinate, improve, or otherwise enhance mental health counseling, treatment, or support to the family caregivers of veterans participating in the family caregiver program.

``(2) Each<<NOTE: application submitted under paragraph (1) shall include the following:

Plans.>> Each application submitted under paragraph (1) shall include the following:

``(c)[[Page Distribution.--The138 SecretarySTAT. shall seek to ensure that grants and contracts awarded under this section are equitably distributed among entities located in States with varying levels of urbanization.

2725]] ``(c) Distribution.--The Secretary shall seek to ensure that grants and contracts awarded under this section are equitably distributed among entities located in States with varying levels of urbanization.

``(2) Not<<NOTE: less frequently than annually, the Secretary shall submit to Congress a report on such tracking requirements.

Reports.>> Not less frequently than annually, the Secretary shall submit to Congress a report on such tracking requirements.

and ``(2) make<<NOTE: information regarding such performance publicly available.

Public information.>> make information regarding such performance publicly available.

``(k) Supplement, Not Supplant.--Any grant or contract awarded under this section shall be used to supplement and not supplant[[Page funding138 thatSTAT. is otherwise available through the Department to provide mental health support among family caregivers of veterans participating in the family caregiver program.

``(l)2726]] Outreachsupplant tofunding Familythat Caregivers.--Theis Secretaryotherwise shallavailable include,through in the outreachDepartment materials regularly provided to aprovide family caregiver who participates in the family caregiver program, notice of mental health support providedamong byfamily recipientscaregivers of grantsveterans orparticipating contracts under this section that are located in the relevantfamily Veteranscaregiver Integratedprogram. Service Network.

``(l) <<NOTE:

Notice.>> Outreach to Family Caregivers.--The Secretary shall include, in the outreach materials regularly provided to a family caregiver who participates in the family caregiver program, notice of mental health support provided by recipients of grants or contracts under this section that are located in the relevant Veterans Integrated Service Network.

``(n) Authorization<<NOTE: of Appropriations.--There is authorized to be appropriated to the Secretary, for each of fiscal years 2025 and 2026, $10,000,000 to carry out this section.

Time periods.>> Authorization of Appropriations.-- There is authorized to be appropriated to the Secretary, for each of fiscal years 2025 and 2026, $10,000,000 to carry out this section.

(a) Programs.--Such<<NOTE: subchapter is further amended by inserting after section 1720K (as added by section 122) the following new section (and conforming the table of sections at the beginning of such chapter accordingly):

38 USC prec.

1701.>> Programs.--Such subchapter is further amended by inserting after section 1720K (as added by section 122) the following new section (and conforming the table of sections at the beginning of such chapter accordingly):

Home-<<NOTE: and community-based services:

38 USC 1720L.>> Home- and community-based services:

``(b) Veteran-Directed Care Program.--(1) The Secretary of Veterans Affairs, in collaboration with the Secretary of Health and Human Services, shall carry out a program to be known as the `Veteran-`Veteran-Directed Directed Care program'.

Under<<NOTE: such program, the Secretary of Veterans Affairs may enter into agreements with the providers described in paragraph (2) to provide to eligible veterans funds, to the extent practicable, to obtain such in-home care services and related items that support clinical need and improve quality of life, as may be determined appropriate by the Secretary of Veterans Affairs and selected by the veteran, including through the veteran hiring individuals to provide such services and items or directly purchasing such services and items.

``(2)Contracts.>> TheUnder such program, the Secretary of Veterans Affairs may enter into agreements with the providers described in this paragraph are(2) to provide to eligible veterans funds, to the following:extent practicable, to obtain such in-home care services and related items that support clinical need and improve quality of life, as may be determined appropriate by the Secretary of Veterans Affairs and selected by the veteran, including through the veteran hiring individuals to provide such services and items or directly purchasing such services and items.

[[Page 138 STAT.

2727]] ``(2) The providers described in this paragraph are the following:

``(c) Homemaker<<NOTE: and Home Health Aide Program.--(1) The Secretary shall carry out a program to be known as the `Homemaker and Home Health Aide program' under which the Secretary may enter into agreements with home health agencies to provide to eligible veterans such home health aide services as may be determined appropriate by the Secretary.

Contracts.>> Homemaker and Home Health Aide Program.-- (1) The Secretary shall carry out a program to be known as the `Homemaker and Home Health Aide program' under which the Secretary may enter into agreements with home health agencies to provide to eligible veterans such home health aide services as may be determined appropriate by the Secretary.

``(f)[[Page Caregiver138 Support.--(1)STAT. With respect to a resident eligible caregiver of a veteran participating in a program under this section, the Secretary shall-- ``(A) if the veteran meets the requirements of a covered veteran under section 1720G(b) of this title, provide to such caregiver the option of enrolling in the program of general caregiver support services under such section;

2728]] ``(f) <<NOTE:

Time period.>> Caregiver Support.--(1) With respect to a resident eligible caregiver of a veteran participating in a program under this section, the Secretary shall-- ``(A) if the veteran meets the requirements of a covered veteran under section 1720G(b) of this title, provide to such caregiver the option of enrolling in the program of general caregiver support services under such section;

``(2) Covered<<NOTE: respite care provided to a resident eligible caregiver of a veteran under paragraph (1) may exceed 30 days annually if such extension is requested by the resident eligible caregiver or veteran and determined medically appropriate by the Secretary.

Determination.>> Covered respite care provided to a resident eligible caregiver of a veteran under paragraph (1) may exceed days annually if such extension is requested by the resident eligible caregiver or veteran and determined medically appropriate by the Secretary.

``(9)[[Page The138 termsSTAT. `Native American' and `Native American veteran' have the meanings given those terms in section 3765 of this title.

2729]] ``(9) The terms `Native American' and `Native American veteran' have the meanings given those terms in section 3765 of this title.

(b) Deadline<<NOTE: for Improved Administration.--The Secretary of Veterans Affairs shall ensure that the Veteran-Directed Care program and the Homemaker and Home Health Aide program are administered through each medical center of the Department of Veterans Affairs in accordance with section 1720L of title 38, United States Code (as added by subsection (a)), by not later than two years after the date of the enactment of this Act.

(c)38 AdministrationUSC of1720L Veteran-Directednote.>> CareDeadline Program.--for (1)Improved Procedures.--Administration.--The (A) The Secretary shallof establishVeterans proceduresAffairs to--shall (i)ensure identifythat the staffingVeteran-Directed needsCare forprogram and the Veteran-DirectedHomemaker Careand Home Health Aide program are administered through each medical center of the Department of Veterans Affairs underin suchaccordance with section 1720L of title 38, United States Code (as added by subsection (a));(a)), by not later than two years after the date of the enactment of this Act.

(c) <<NOTE:

38 USC 1720L note.>> Administration of Veteran-Directed Care Program.-- (1) Procedures.-- (A) The Secretary shall establish procedures to-- (i) identify the staffing needs for the Veteran-Directed Care program of the Department of Veterans Affairs under such section (as added by subsection (a));

(i) A description of-- (I)[[Page the138 staffingSTAT. model described in subparagraph (A);

2730]] (I) the staffing model described in subparagraph (A);

``(ii) assess<<NOTE: the veteran or caregiver for participation in any other available program of the Department for home- and community-based services (including the programs specified in section 1720L of this title) for which the veteran or caregiver may be eligible and, with respect to the veteran, store (and make accessible to the veteran) the results of such assessment in the electronic medical record of the veteran;

andAssessment.>> ``(iii)assess provide to the veteran or caregiver writtenfor informationparticipation onin any suchother available program identifiedof pursuantthe toDepartment thefor assessmenthome- underand clausecommunity-based (ii),services including(including informationthe aboutprograms facilities,specified eligibilityin requirements,section and1720L relevantof contactthis informationtitle) for eachwhich the veteran or caregiver may be eligible and, with respect to the veteran, store (and make accessible to the veteran) the results of such program.assessment in the electronic medical record of the veteran;

and ``(iii) <<NOTE:

Notification.>> provide to the veteran or caregiver written information on any such program identified pursuant to the assessment under clause (ii), including information about facilities, eligibility requirements, and relevant contact information for each such program.

(2)[[Page Applicability.--The138 amendmentsSTAT. made by paragraph (1) shall apply with respect to denials and discharges occurring on or after the date that is 180 days after the date of the enactment of this Act.

(3)2731]] Technical(2) and<<NOTE: conforming amendments.--Section 1720G(d) of such title is amended-- (A) by striking ``or a covered veteran'' each place it appears and inserting ``, a veteran denied or discharged as specified in paragraph (14) of such subsection, or a covered veteran'';

Effective date.

Time period.

38 USC 1720G note.>> Applicability.--The amendments made by paragraph (1) shall apply with respect to denials and discharges occurring on or after the date that is 180 days after the date of the enactment of this Act.

(3) Technical and conforming amendments.--Section 1720G(d) of such title <<NOTE:

38 USC 1720G.>> is amended-- (A) by striking ``or a covered veteran'' each place it appears and inserting ``, a veteran denied or discharged as specified in paragraph (14) of such subsection, or a covered veteran'';

``(2) The<<NOTE: term `covered respite care' means, with respect to a caregiver of a veteran, respite care under section 1720B of this title that-- ``(A) is medically and age appropriate for the veteran (including 24-hour per day care of the veteran commensurate with the care provided by the caregiver);

Definition.

Time period.>> The term `covered respite care' means, with respect to a caregiver of a veteran, respite care under section 1720B of this title that-- ``(A) is medically and age appropriate for the veteran (including 24-hour per day care of the veteran commensurate with the care provided by the caregiver);

Section 1720G(a) of title 38, United States Code, as amended by section 124, is further amended-- (1) in paragraph (12)-- (A) in subparagraph (A), by inserting ``, which shall include all criteria used to determine eligibility for such assistance and, in the case of a completed evaluation, how such[[Page criteria138 wereSTAT. used to evaluate information provided in assessments to determine such eligibility'' before the period at the end;

2732]] such criteria were used to evaluate information provided in assessments to determine such eligibility'' before the period at the end;

``(15)(A) Not<<NOTE: less frequently than annually, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a comprehensive report on the program required by paragraph (1) that includes, with respect to the one-year period preceding the date of the submission of such report, the following:

Time periods.

Reports.>> Not less frequently than annually, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a comprehensive report on the program required by paragraph (1) that includes, with respect to the one-year period preceding the date of the submission of such report, the following:

``(B) The<<NOTE: Secretary shall ensure that all data included in a report under subparagraph (A)-- ``(i) relating to a decision made under the program required by paragraph (1), are disaggregated by the specific reason for the decision;

Data.>> The Secretary shall ensure that all data included in a report under subparagraph (A)-- [[Page 138 STAT.

2733]] ``(i) relating to a decision made under the program required by paragraph (1), are disaggregated by the specific reason for the decision;

IMPROVEMENTS<<NOTE: RELATING TO HOMEMAKER AND HOME HEALTH AIDE PROGRAM.

(a)38 PilotUSC Program1720L fornote.>> CommunitiesIMPROVEMENTS WithRELATING ShortageTO ofHOMEMAKER HomeAND HealthHOME Aides.--HEALTH (1)AIDE Program.--BeginningPROGRAM. not later than 18 months after the date of the enactment of this Act, the Secretary shall carry out a three-year pilot program under which the Secretary shall provide homemaker and home health aide services to veterans who reside in communities with a shortage of home health aides.

(2)(a) Locations.--ThePilot SecretaryProgram shallfor selectCommunities notWith fewerShortage than five geographic locations in which the Secretary determines there is a shortage of homeHome healthHealth aidesAides.-- at(1) which<<NOTE: to carry out the pilot program under paragraph (1).

Deadline.

Time period.>> Program.--Beginning not later than 18 months after the date of the enactment of this Act, the Secretary shall carry out a three-year pilot program under which the Secretary shall provide homemaker and home health aide services to veterans who reside in communities with a shortage of home health aides.

(2) <<NOTE:

Determination.>> Locations.--The Secretary shall select not fewer than five geographic locations in which the Secretary determines there is a shortage of home health aides at which to carry out the pilot program under paragraph (1).

(4)[[Page Report138 toSTAT. congress.--Not later than one year before the date of the termination of the pilot program under paragraph (1), the Secretary shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report that includes-- (A) a statement of the results of such pilot program;

and2734]] (B)(4) anReport assessmentto congress.--Not later than one year before the date of the feasibilitytermination of the pilot program under paragraph (1), the Secretary shall submit to the Committees on Veterans' Affairs of the House of Representatives and advisabilitythe of--Senate (i)a extendingreport suchthat pilotincludes-- program;(A) <<NOTE:

Statement.>> a statement of the results of such pilot program;

and (B) <<NOTE:

Assessment.>> an assessment of the feasibility and advisability of-- (i) extending such pilot program;

(b) Report<<NOTE: on Use of Funds.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report containing, with respect to the period beginning in fiscal year 2012 and ending in fiscal year 2024, the following:

Time period.>> Report on Use of Funds.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report containing, with respect to the period beginning in fiscal year 2012 and ending in fiscal year 2024, the following:

(c) Updated<<NOTE: Guidance on Program.--Not later than one year after the date of the enactment of this Act, the Secretary shall issue updated guidance for the Homemaker and Home Health Aide program.

Deadline.

Process.>> Updated Guidance on Program.--Not later than one year after the date of the enactment of this Act, the Secretary shall issue updated guidance for the Homemaker and Home Health Aide program.

PILOT<<NOTE: PROGRAM TO FURNISH ASSISTED LIVING SERVICES TO CERTAIN VETERANS.

(a)38 Establishment.--BeginningUSC not1710B laternote.>> thanPILOT twoPROGRAM yearsTO afterFURNISH theASSISTED dateLIVING ofSERVICES theTO enactmentCERTAIN ofVETERANS. this Act, the Secretary of Veterans Affairs shall carry out a pilot program to assess-- (1) the effectiveness of providing assisted living services to eligible veterans, at the election of such veterans;

(a) <<NOTE:

Deadline.

Assessments.>> Establishment.--Beginning not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to assess-- (1) the effectiveness of providing assisted living services to eligible veterans, at the election of such veterans;

(b) Program Locations.-- (1)[[Page Veterans138 integratedSTAT. service networks.--The Secretary shall select two Veterans Integrated Service Networks of the Department of Veterans Affairs at which to carry out the pilot program under subsection (a).

2735]] (1) Veterans integrated service networks.--The Secretary shall select two Veterans Integrated Service Networks of the Department of Veterans Affairs at which to carry out the pilot program under subsection (a).

(ii) not fewer than one such facility serves veterans in rural or highly rural areas (as determined through the use of the Rural-Rural-Urban Urban Commuting Areas coding system of the Department of Agriculture);

(2) Standards.--The<<NOTE: Secretary may not place, transfer, or admit a veteran to any facility for assisted living services under the pilot program under subsection (a)(1) unless the Secretary determines that-- (A) the facility meets the standards for community residential care established under sections 17.61 through 17.72 of title 38, Code of Federal Regulations, or successor regulations, and any additional standards of care as the Secretary may specify;

Determination.>> Standards.--The Secretary may not place, transfer, or admit a veteran to any facility for assisted living services under the pilot program under subsection (a)(1) unless the Secretary determines that-- (A) the facility meets the standards for community residential care established under sections 17.61 through 17.72 of title 38, Code of Federal Regulations, or successor regulations, and any additional standards of care as the Secretary may specify;

and (B)[[Page with138 respectSTAT. to any other facility, not less frequently than annually and in the same manner as the Secretary conducts inspection of facilities under section 1730 of such title.

2736]] (B) with respect to any other facility, not less frequently than annually and in the same manner as the Secretary conducts inspection of facilities under section 1730 of such title.

(5) an identification of any barriers or challenges to furnishing care to veterans under the pilot program, conducting oversight[[Page of138 theSTAT. pilot program, or any other barriers or challenges;

(6)2737]] theoversight cost of care at each assisted living facility and State home participating in the pilot program, includingor an analysis of any costother savingsbarriers byor thechallenges; Department when comparing that cost to the cost of nursing home care;

(6) <<NOTE:

Costs.

Cost analysis.>> the cost of care at each assisted living facility and State home participating in the pilot program, including an analysis of any cost savings by the Department when comparing that cost to the cost of nursing home care;

(2) includes<<NOTE: recommendations on whether the model studied in the pilot program should be continued or adopted throughout the Department;

Recommenda- tions.>> includes recommendations on whether the model studied in the pilot program should be continued or adopted throughout the Department;

(2) Elements.--The<<NOTE: report required by paragraph (1) shall include an assessment of-- (A) the quality of care provided to veterans at facilities participating in the pilot program, measured pursuant to the method determined under subsection (f);

Assessment.>> Elements.--The report required by paragraph (1) shall include an assessment of-- (A) the quality of care provided to veterans at facilities participating in the pilot program, measured pursuant to the method determined under subsection (f);

(2) The term ``eligible veteran'' means a veteran who is-- (A)[[Page receiving138 nursingSTAT. home care paid for by the Department of Veterans Affairs, eligible to receive such care pursuant to section 1710A of title 38, United States Code, or requires a higher level of care than the domiciliary care provided by the Department of Veterans Affairs, but does not meet the requirements for nursing home level care provided by the Department pursuant to such section;

2738]] (A) receiving nursing home care paid for by the Department of Veterans Affairs, eligible to receive such care pursuant to section 1710A of title 38, United States Code, or requires a higher level of care than the domiciliary care provided by the Department of Veterans Affairs, but does not meet the requirements for nursing home level care provided by the Department pursuant to such section;

PROVISION<<NOTE: OF MEDICINE, EQUIPMENT, AND SUPPLIES AVAILABLE TO DEPARTMENT OF VETERANS AFFAIRS TO STATE HOMES.

38 USC 1741 note.>> PROVISION OF MEDICINE, EQUIPMENT, AND SUPPLIES AVAILABLE TO DEPARTMENT OF VETERANS AFFAIRS TO STATE HOMES.

RECOGNITION<<NOTE: OF ORGANIZATIONS AND INDIVIDUALS TO ASSIST VETERANS, FAMILY MEMBERS, AND CAREGIVERS NAVIGATING PROGRAMS AND SERVICES OF VETERANS HEALTH ADMINISTRATION.

(a)38 InUSC General.--Not1720G laternote.>> thanRECOGNITION oneOF yearORGANIZATIONS afterAND theINDIVIDUALS dateTO ofASSIST theVETERANS, enactmentFAMILY ofMEMBERS, thisAND Act,CAREGIVERS theNAVIGATING SecretaryPROGRAMS ofAND VeteransSERVICES AffairsOF shallVETERANS establishHEALTH aADMINISTRATION. process through which the Department of Veterans Affairs may recognize organizations and individuals to assist a veteran, a family member of a veteran, or a caregiver of a veteran (as defined in section 1720G(d) of title 38, United States Code) in navigating the programs and services of the Veterans Health Administration.

(b) Solicitation of Feedback.--The Secretary shall solicit feedback and recommendations in the creation of the process under subsection (a) from<<NOTE: such organizations as the Secretary may consider relevant.

Deadline.

Process.>> In General.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a process through which the Department of Veterans Affairs may recognize organizations and individuals to assist a veteran, a family member of a veteran, or a caregiver of a veteran (as defined in section 1720G(d) of title 38, United States Code) in navigating the programs and services of the Veterans Health Administration.

(b) <<NOTE:

Recommenda- tions.>> Solicitation of Feedback.--The Secretary shall solicit feedback and recommendations in the creation of the process under subsection (a) from such organizations as the Secretary may consider relevant.

REVIEWS<<NOTE: AND OTHER IMPROVEMENTS RELATING TO HOME- AND COMMUNITY-BASED SERVICES.

(a)38 OfficeUSC of1720L Geriatricnote.>> andREVIEWS ExtendedAND Care.--OTHER (1)IMPROVEMENTS ReviewRELATING ofTO programs.--TheHOME- UnderAND SecretaryCOMMUNITY-BASED forSERVICES. Health of the Department of Veterans Affairs shall conduct a review of each program administered through the Office of Geriatric and Extended Care of the Department and the Caregiver Support Program Office of the Department, or any successor offices, to-- (A) eliminate service gaps at the medical center level;

(a) Office of Geriatric and Extended Care.-- [[Page 138 STAT.

2739]] (1) Review of programs.--The Under Secretary for Health of the Department of Veterans Affairs shall conduct a review of each program administered through the Office of Geriatric and Extended Care of the Department and the Caregiver Support Program Office of the Department, or any successor offices, to-- (A) eliminate service gaps at the medical center level;

(b) Review of Incentives and Efforts Relating to Home- and Community-based Services.-- (1)[[Page Review.--The138 SecretarySTAT. of Veterans Affairs shall conduct a review of the following:

2740]] (1) Review.--The Secretary of Veterans Affairs shall conduct a review of the following:

(c) Review<<NOTE: of Respite Care Services.--Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct a review of the use, availability, cost, and effectiveness, of the respite care services furnished by the Secretary under chapter 17 of title 38, United States Code, including-- (1) the frequency at which the Department of Veterans Affairs is unable to meet demand for such services;

Deadline.>> Review of Respite Care Services.--Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall conduct a review of the use, availability, cost, and effectiveness, of the respite care services furnished by the Secretary under chapter 17 of title 38, United States Code, including-- (1) the frequency at which the Department of Veterans Affairs is unable to meet demand for such services;

(i) With respect to home- and community-community-based based services for veterans, the Secretary of Veterans Affairs shall develop recommendations regarding new services (in addition to those furnished as of the date of enactment of this Act) in collaboration with the Secretary of Health and Human Services.

(B)[[Page Submission138 toSTAT. congress.--The Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report containing the recommendations developed under subparagraph (A) and an identification of any changes in existing law or new statutory authority necessary to implement the recommendations, as determined by the Secretary.

2741]] (B) <<NOTE:

Reports.

Determination.>> Submission to congress.--The Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the House of Representatives and the Senate a report containing the recommendations developed under subparagraph (A) and an identification of any changes in existing law or new statutory authority necessary to implement the recommendations, as determined by the Secretary.

(b) Contents.--The<<NOTE: report submitted under subsection (a) shall include the following:

Assessments.>> Contents.--The report submitted under subsection (a) shall include the following:

(3)[[Page An138 assessmentSTAT. of the availability and accessibility of mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs.

2742]] (3) An assessment of the availability and accessibility of mental health support in facilities of the Department and in the community for caregivers participating in the caregiver programs.

DEVELOPMENT<<NOTE: OF CENTRALIZED WEBSITE FOR PROGRAM INFORMATION.

(a)38 CentralizedUSC Website.--The1720L Secretarynote.>> shallDEVELOPMENT developOF andCENTRALIZED maintainWEBSITE aFOR centralizedPROGRAM andINFORMATION. publically accessible internet website of the Department as a clearinghouse for information and resources relating to covered programs.

(a) <<NOTE:

Public information.>> Centralized Website.--The Secretary shall develop and maintain a centralized and publically accessible internet website of the Department as a clearinghouse for information and resources relating to covered programs.

(3) A<<NOTE: list of required procedures for the directors of the medical facilities of the Department to follow in determining the eligibility and suitability of veterans for participation in a covered program, including procedures applicable to instances in which the resource constraints of a facility (or of a community in which a facility is located) may result in the inability to address the health needs of a veteran under a covered program in a timely manner.

List.>> A list of required procedures for the directors of the medical facilities of the Department to follow in determining the eligibility and suitability of veterans for participation in a covered program, including procedures applicable to instances in which the resource constraints of a facility (or of a community in which a facility is located) may result in the inability to address the health needs of a veteran under a covered program in a timely manner.

DEFINITIONS.<<NOTE:

38 USC 1720L note.>> DEFINITIONS.

(3)[[Page The138 termSTAT. ``home- and community-based services''-- (A) means the services referred to in section 1701(6)(E) of title 38, United States Code;

2743]] (3) The term ``home- and community-based services''-- (A) means the services referred to in section 1701(6)(E) of title 38, United States Code;

(a) In General.--Subchapter I of chapter 17 of title 38, United States Code, is<<NOTE: amended by inserting after section 1703F the following new section (and amending the table of sections at the beginning of such chapter accordingly):

38 USC prec.

1701.>> is amended by inserting after section 1703F the following new section (and amending the table of sections at the beginning of such chapter accordingly):

Quarterly<<NOTE: report on referrals for non-Department health care ``The Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a quarterly report containing, with respect to referrals for non-Department health care originating from a medical facility of the Department during the quarter preceding the date of the submission of the report, a measurement of, for each such medical facility-- ``(1) the period of time between-- ``(A) the date on which a clinician employed by the Department determines that a veteran requires care, or a veteran presents to the Department requesting care, and the date on which the referral for care is sent to a non-Department health care provider;

38 USC 1703G.>> Quarterly report on referrals for non-Department health care ``The Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a quarterly report containing, with respect to referrals for non-Department health care originating from a medical facility of the Department during the quarter preceding the date of the submission of the report, a measurement of, for each such medical facility-- ``(1) <<NOTE:

Time periods.>> the period of time between-- ``(A) the date on which a clinician employed by the Department determines that a veteran requires care, or a veteran presents to the Department requesting care, and the date on which the referral for care is sent to a non-Department health care provider;

and ``(2)[[Page any138 otherSTAT. period of time that the Secretary determines necessary.''.

(b)2744]] Effective``(2) Date.--Theany firstother reportperiod underof sectiontime 1703G,that as added by this section, shall be due not later than 180 days after the dateSecretary ofdetermines thenecessary.''. enactment of this section.

(b) <<NOTE:

38 USC 1703G note.>> Effective Date.--The first report under section 1703G, as added by this section, shall be due not later than 180 days after the date of the enactment of this section.

``(8) Not<<NOTE: later than 120 days after the end of each fiscal year, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report that includes the following:

Reports.

Lists.>> Not later than 120 days after the end of each fiscal year, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report that includes the following:

``(iii)[[Page whether138 aSTAT. market pay adjustment was made following the evaluation per each occupation and specialty evaluated;

2745]] ``(iii) whether a market pay adjustment was made following the evaluation per each occupation and specialty evaluated;

``(C) A<<NOTE: list of facilities of the Department that have not conducted an evaluation of market pay, pursuant to paragraph (5), during the 18-month-period that precedes the date of the submission of such report.'';

Time period.>> A list of facilities of the Department that have not conducted an evaluation of market pay, pursuant to paragraph (5), during the 18- month-period that precedes the date of the submission of such report.'';

``(6)(A) The<<NOTE: Secretary may waive any pay limitation described in this section (including tier limitations) that the Secretary determines necessary for the recruitment or retention of critical health care personnel whom the Secretary determines would provide direct patient care.

Waiver authority.>> The Secretary may waive any pay limitation described in this section (including tier limitations) that the Secretary determines necessary for the recruitment or retention of critical health care personnel whom the Secretary determines would provide direct patient care.

``(F) Not<<NOTE: later than 180 days after the date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, and annually thereafter, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report that includes-- ``(i) any updates to the requirements, limitations, and considerations prescribed under subparagraph (B) during the period covered by the report;

Reports.>> Not later than 180 days after the date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, and annually thereafter, the Secretary shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report that includes-- [[Page 138 STAT.

2746]] ``(i) <<NOTE:

Updates.>> any updates to the requirements, limitations, and considerations prescribed under subparagraph (B) during the period covered by the report;

and ``(iv) a<<NOTE: list of any separation actions during the period covered by the report with respect to a position for which a waiver under subparagraph (A) is in effect.

``(G)List.>> Thea authoritylist of theany Secretaryseparation underactions subparagraphduring (A) shall terminate on the lastperiod daycovered ofby the thirdreport fullwith fiscalrespect yearto followinga theposition datefor ofwhich thea enactmentwaiver ofunder thesubparagraph Senator(A) Elizabethis Dolein 21steffect. Century Veterans Healthcare and Benefits Improvement Act.''.

``(G) <<NOTE:

Termination.>> The authority of the Secretary under subparagraph (A) shall terminate on the last day of the third full fiscal year following the date of the enactment of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act.''.

(4) Clerical amendments.-- (A) Subchapter heading.--Subchapter III of chapter of such title is<<NOTE: amended in the heading by inserting ``Optometrists,'' after ``PODIATRISTS,''.

(B)38 TableUSC ofprec. sections.--The table of sections for such chapter is amended by striking the item relating to subchapter III and inserting the following:

7431.>> is amended in the heading by inserting ``Optometrists,'' after ``PODIATRISTS,''.

(B) Table of sections.--The table of sections for such chapter is <<NOTE:

38 USC prec.

7401.>> amended by striking the item relating to subchapter III and inserting the following:

(5) Applicability<<NOTE: dates.--The amendments made by this subsection shall apply to any pay period of the Department of Veterans Affairs beginning on or after the date that is 180 days after the date of the enactment of this Act.

Effective date.

Time period.

38 USC 7431 note.>> Applicability dates.--The amendments made by this subsection shall apply to any pay period of the Department of Veterans Affairs beginning on or after the date that is 180 days after the date of the enactment of this Act.

and (2)[[Page in138 subsectionSTAT. (b)-- (A) by striking ``podiatrist (dpm), and dentist'' and inserting ``podiatrist (dpm), optometrist (od), and dentist'';

2747]] (2) in subsection (b)-- (A) by striking ``podiatrist (dpm), and dentist'' and inserting ``podiatrist (dpm), optometrist (od), and dentist'';

(c) Retroactive<<NOTE: Authority for Compensation.-- (1) In general.--The Secretary of Veterans Affairs may pay retroactive compensation to a covered employee in an amount that equals the amount of compensation that was authorized to be paid to such covered employee during the period specified in paragraph (2), but was deferred and paid to such employee in the calendar year following the calender year in which such compensation was authorized because the payment such compensation would have exceeded an applicable cap on annual compensation.

38 USC 7431 note.>> Retroactive Authority for Compensation.-- (1) In general.--The Secretary of Veterans Affairs may pay retroactive compensation to a covered employee in an amount that equals the amount of compensation that was authorized to be paid to such covered employee during the period specified in paragraph (2), but was deferred and paid to such employee in the calendar year following the calender year in which such compensation was authorized because the payment such compensation would have exceeded an applicable cap on annual compensation.

REIMBURSEMENT<<NOTE: OF AMBULANCE COST FOR CARE FOR CERTAIN RURAL VETERANS.

(a)38 InUSC General.--The1728 Secretarynote.>> ofREIMBURSEMENT VeteransOF AffairsAMBULANCE shallCOST pay,FOR orCARE reimburseFOR aCERTAIN coveredRURAL veteranVETERANS. for, the cost of transporting the veteran by ambulance, including air ambulance, from a covered location to a provider of the Department of Veterans Affairs, a non-Department provider, or the nearest hospital that can meet the needs of the veteran (including a hospital that compacts with the Indian Health Service) for covered care.

(b)(a) Amount<<NOTE: Covered.--The maximum cumulative amount covered under this section for a covered veteran is $46,000.

Payment.>> In General.--The Secretary of Veterans Affairs shall pay, or reimburse a covered veteran for, the cost of transporting the veteran by ambulance, including air ambulance, from a covered location to a provider of the Department of Veterans Affairs, a non-Department provider, or the nearest hospital that can meet the needs of the veteran (including a hospital that compacts with the Indian Health Service) for covered care.

[[Page 138 STAT.

2748]] (b) Amount Covered.--The maximum cumulative amount covered under this section for a covered veteran is $46,000.

and (C) is not entitled to care or services under a non-Departmentnon- Department of Veterans Affairs health-plan contract.

PILOT<<NOTE: PROGRAM TO FURNISH DENTAL CARE FROM THE DEPARTMENT OF VETERANS AFFAIRS TO CERTAIN VETERANS DIAGNOSED WITH ISCHEMIC HEART DISEASE.

(a)38 InUSC General.--Beginning1712 notnote.>> laterPILOT thanPROGRAM oneTO yearFURNISH afterDENTAL theCARE dateFROM ofTHE theDEPARTMENT enactmentOF ofVETERANS thisAFFAIRS Act,TO theCERTAIN SecretaryVETERANS ofDIAGNOSED VeteransWITH AffairsISCHEMIC shallHEART carryDISEASE. out a two-year pilot program (in this section referred to as the ``pilot program'') under which the Secretary shall furnish covered care to covered veterans through means that include the use of community care.

(a) <<NOTE:

Deadline.>> In General.--Beginning not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a two-year pilot program (in this section referred to as the ``pilot program'') under which the Secretary shall furnish covered care to covered veterans through means that include the use of community care.

(2) Selection<<NOTE: criteria.--In selecting States under paragraph (1), the Secretary shall prioritize States in which-- (A) the Department of Veterans Affairs serves a high proportion, as determined by the Secretary, of veterans residing in rural or highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture);

Determinations.>> Selection criteria.--In selecting States under paragraph (1), the Secretary shall prioritize States in which-- (A) the Department of Veterans Affairs serves a high proportion, as determined by the Secretary, of veterans residing in rural or highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture);

or (D)[[Page the138 SecretarySTAT. determines a large percentage of veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under paragraphs (1) or (2) of section 1705(a) of title 38, United States Code, visit emergency rooms for dental emergencies at high rates.

2749]] (D) the Secretary determines a large percentage of veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under paragraphs (1) or (2) of section 1705(a) of title 38, United States Code, visit emergency rooms for dental emergencies at high rates.

(B) Expansion<<NOTE: of network.--If, pursuant to a review under subparagraph (A), the Secretary determines the community care network in a State selected under subsection (b)(1) is not capable of receiving an influx of patients under the pilot program, the Secretary shall coordinate with the Third Party Administrator for such State to ensure the dental provider network of such community care network is sufficiently expanded before the initiation of the pilot program.

Determination.>> Expansion of network.-- If, pursuant to a review under subparagraph (A), the Secretary determines the community care network in a State selected under subsection (b)(1) is not capable of receiving an influx of patients under the pilot program, the Secretary shall coordinate with the Third Party Administrator for such State to ensure the dental provider network of such community care network is sufficiently expanded before the initiation of the pilot program.

(3) Loss<<NOTE: of eligibility.--Any veteran participating in the pilot program who ceases to be a covered veteran shall be removed from the pilot program on the date that is 90 days after the Secretary determines the participant is no longer a covered veteran.

(4)Time Continuityperiod. of care.-- (A) In general.--Upon the termination of the pilot program, the Secretary shall provide to all veterans participating in the pilot program at the time of such termination-- (i) information on how to enroll in the dental insurance plan of the Department of Veterans Affairs under section 1712C of title 38, United States Code;

Determination.>> Loss of eligibility.--Any veteran participating in the pilot program who ceases to be a covered veteran shall be removed from the pilot program on the date that is 90 days after the Secretary determines the participant is no longer a covered veteran.

(4) Continuity of care.-- [[Page 138 STAT.

2750]] (A) In general.--Upon the termination of the pilot program, the Secretary shall provide to all veterans participating in the pilot program at the time of such termination-- (i) information on how to enroll in the dental insurance plan of the Department of Veterans Affairs under section 1712C of title 38, United States Code;

(G) an<<NOTE: analysis of the communication and collaboration of the Department with Third Party Administrators and community care dental providers, disaggregated by State;

(H)Analysis.>> an analysis of anythe costcommunication savingsand bycollaboration of the Department with respectThird toParty theAdministrators treatmentand ofcommunity ischemiccare heartdental disease;providers, disaggregated by State;

(I)(H) an<<NOTE: assessment of the impact of the pilot program on appointments for care, prescriptions, hospitalizations, emergency room visits, wellness, employability, satisfaction, and perceived quality of life of covered veterans related to their diagnosis of ischemic heart disease;

(J)Analysis.>> an analysis and assessment of theany efficacycost ofsavings mobileby clinics and portable dental care units, to the extentDepartment suchwith modalitiesrespect are used, to service the needstreatment of coveredischemic veteransheart underdisease; the pilot program;

(K)(I) an<<NOTE: analysis and assessment of the usage of teledentistry to service the needs of covered veterans under the pilot program, to include a cost benefit analysis of such services;

Assessment.>> an assessment of the impact of the pilot program on appointments for care, prescriptions, hospitalizations, emergency room visits, wellness, employability, satisfaction, and perceived quality of life of covered veterans related to their diagnosis of ischemic heart disease;

[[Page 138 STAT.

2751]] (J) <<NOTE:

Analysis.

Assessment.>> an analysis and assessment of the efficacy of mobile clinics and portable dental care units, to the extent such modalities are used, to service the needs of covered veterans under the pilot program;

(K) <<NOTE:

Analysis.

Assessment.>> an analysis and assessment of the usage of teledentistry to service the needs of covered veterans under the pilot program, to include a cost benefit analysis of such services;

(B) includes<<NOTE: recommendations on whether the pilot program should be continued, expanded, or adopted throughout the Department;

Recommenda- tions.>> includes recommendations on whether the pilot program should be continued, expanded, or adopted throughout the Department;

(g) Impact on Community Care.--Participants in the pilot program shall be able to access covered care in the community under section 1703 of title 38, United States Code.

DOCUMENTATION<<NOTE: OF PREFERENCES OF VETERANS FOR SCHEDULING OF APPOINTMENTS FOR HEALTH CARE UNDER LAWS ADMINISTERED BY SECRETARY OF VETERANS AFFAIRS.

(a)38 InUSC General.--Not1701 laternote.>> thanDOCUMENTATION oneOF yearPREFERENCES afterOF theVETERANS dateFOR ofSCHEDULING theOF enactmentAPPOINTMENTS ofFOR thisHEALTH Act,CARE theUNDER SecretaryLAWS ofADMINISTERED VeteransBY AffairsSECRETARY shallOF developVETERANS aAFFAIRS. mechanism to solicit information regarding the preference of 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, for scheduling of appointments for health care and related services under the laws administered by the Secretary, including through non-Department providers.

(b) Documentation of Preference.--Preferences provided voluntarily by a veteran pursuant to subsection (a) shall<<NOTE: be documented on My HealtheVet or another system designated by the Secretary that allows the veteran to view and change such preferences at any time.

Deadline.>> In General.--Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop a mechanism to solicit information regarding the preference of 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, for scheduling of appointments for health care and related services under the laws administered by the Secretary, including through non-Department providers.

[[Page 138 STAT.

2752]] (b) Documentation of Preference.--Preferences provided voluntarily by a veteran pursuant to subsection (a) shall be documented on My HealtheVet or another system designated by the Secretary that allows the veteran to view and change such preferences at any time.

STAFFING<<NOTE: MODEL AND PERFORMANCE METRICS FOR CERTAIN EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS.

(a)38 StaffingUSC Model.--1701 (1)note.>> InSTAFFING general.--NotMODEL laterAND thanPERFORMANCE oneMETRICS yearFOR afterCERTAIN theEMPLOYEES dateOF ofTHE theDEPARTMENT enactmentOF ofVETERANS thisAFFAIRS. Act, the Secretary of Veterans Affairs shall-- (A) develop, validate, and implement a staffing model for the Office of Integrated Veteran Care of the Department of Veterans Affairs, or successor office, Veterans Integrated Services Networks, and medical centers of the Department that includes appropriate target staffing levels nationally, regionally, and locally to ensure timely access to care and effectively oversee the provision of care by the Department, whether at a facility of the Department or through a non-Department provider;

and(a) (B)Staffing provideModel.-- to(1) Congress<<NOTE: a briefing on such staffing model, which shall include-- (i) the metrics and measures used by the Secretary in developing such staffing model;

(ii)Deadline.>> anIn analysisgeneral.--Not later than one year after the date of howthe suchenactment of this Act, the Secretary of Veterans Affairs shall-- (A) develop, validate, and implement a staffing model comparesfor tothe Office of Integrated Veteran Care of the staffingDepartment modelsof Veterans Affairs, or successor office, Veterans Integrated Services Networks, and medical centers of otherthe relevantDepartment Government-ownedthat includes appropriate target staffing levels nationally, regionally, and privatelocally sectorto healthensure timely access to care systems;and effectively oversee the provision of care by the Department, whether at a facility of the Department or through a non- Department provider;

and (iii)(B) an<<NOTE: estimate of the portion of the roles in such staffing model that will be filled by contracted staff at any given time.

(2)Briefing.>> Reportprovide onto implementationCongress ofa staffingbriefing model.--Not later than one year after the date on whichsuch the Secretary implements the staffing modelmodel, requiredwhich undershall paragraphinclude-- (1),(i) the Secretarymetrics shall submit to Congress and themeasures Comptrollerused Generalby of the UnitedSecretary Statesin adeveloping report containing-- (A) an update on such implementation;staffing model;

[[Page 138 STAT.

2753]] (ii) <<NOTE:

Analysis.>> an analysis of how such staffing model compares to the staffing models of other relevant Government-owned and private sector health care systems;

and (iii) <<NOTE:

Estimate.>> an estimate of the portion of the roles in such staffing model that will be filled by contracted staff at any given time.

(2) Report on implementation of staffing model.--Not later than one year after the date on which the Secretary implements the staffing model required under paragraph (1), the Secretary shall submit to Congress and the Comptroller General of the United States a report containing-- (A) <<NOTE:

Update.>> an update on such implementation;

(b) Performance Metrics.-- (1) In<<NOTE: general.--Not later than one year after the date of the enactment of this Act, the Secretary shall develop and implement a plan, with an appropriate tracking system, to incorporate appropriate standardized performance metrics and oversight measures within the performance appraisal systems for employees of the Department specified in paragraph (2).

Deadline.

Implementation plan.>> In general.-- Not later than one year after the date of the enactment of this Act, the Secretary shall develop and implement a plan, with an appropriate tracking system, to incorporate appropriate standardized performance metrics and oversight measures within the performance appraisal systems for employees of the Department specified in paragraph (2).

(3) Report on implementation of performance metrics.--Not later than one year after implementing the performance metrics required under paragraph (1), the Secretary shall submit to Congress and the Comptroller General of the United States a report containing-- (A) an<<NOTE: update on such implementation;

Update.>> an update on such implementation;

(c) GAO Report.--Not later than two years after the later of the date on which the Comptroller General receives the report under subsection (a)(2) or the report under subsection (b)(3), the Comptroller General shall submit to Congress a report that includes-- (1) an<<NOTE: assessment of the performance of the Office of Integrated Veteran Care of the Department, or successor office, in improving access to care for veterans in facilities of the Department and pursuant to section 1703 of title 38, United States Code;

andAssessment.>> (2)an suchassessment recommendationsof asthe performance of the ComptrollerOffice Generalof considersIntegrated appropriateVeteran withCare respectof tothe Department, or successor office, in improving access to the care describedfor veterans in paragraphfacilities (1)of forthe veterans.Department and pursuant to section 1703 of title 38, United States Code;

and [[Page 138 STAT.

2754]] (2) <<NOTE:

Recommenda- tions.>> such recommendations as the Comptroller General considers appropriate with respect to improving access to the care described in paragraph (1) for veterans.

ONLINE<<NOTE: HEALTH EDUCATION PORTAL FOR VETERANS ENROLLED IN PATIENT ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS AFFAIRS.

Deadline.

38 USC 1701 note.>> ONLINE HEALTH EDUCATION PORTAL FOR VETERANS ENROLLED IN PATIENT ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS AFFAIRS.

LIMITATION<<NOTE: ON DETAIL OF DIRECTORS OF MEDICAL CENTERS OF DEPARTMENT OF VETERANS AFFAIRS TO DIFFERENT POSITIONS.

Deadlines.

38 USC 7401 note.>> LIMITATION ON DETAIL OF DIRECTORS OF MEDICAL CENTERS OF DEPARTMENT OF VETERANS AFFAIRS TO DIFFERENT POSITIONS.

(c) Update<<NOTE: on Detail.--Not later than 120 days after detailing a director of a medical center of the Department to a different position within the Department, and not less frequently than every 30 days thereafter while the detail is in effect or while the director position at the medical center is vacant, 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 regarding the status of the detail.

(d)Time Returnperiod.>> toUpdate Positionon orDetail.--Not Reassignment.-- (1) In general.--Except as provided in paragraph (2), not later than 180120 days after detailing a director of a medical center of the Department to a different position within the Department, forand anot reasonless otherfrequently than anevery ongoing30 investigationdays thereafter while the detail is in effect or administrativewhile actionthe withdirector respectposition toat the director,medical center is vacant, the Secretary shall--shall (A)submit returnto the individualCommittee toon Veterans' Affairs of the positionSenate asand directorthe Committee on Veterans' Affairs of the medicalHouse center;of Representatives an update regarding the status of the detail.

(d) Return to Position or Reassignment.-- (1) In general.--Except as provided in paragraph (2), not later than 180 days after detailing a director of a medical center of the Department to a different position within the Department, for a reason other than an ongoing investigation or administrative action with respect to the director, the Secretary shall-- [[Page 138 STAT.

2755]] (A) return the individual to the position as director of the medical center;

(2) Waiver.-- (A) In<<NOTE: general.--The Secretary may waive the requirement under paragraph (1) with respect to an individual for successive 90-day increments for a total period of not more than 540 days from the original date the individual was detailed away from their position as director of a medical center.

Time period.>> In general.--The Secretary may waive the requirement under paragraph (1) with respect to an individual for successive 90-day increments for a total period of not more than 540 days from the original date the individual was detailed away from their position as director of a medical center.

NATIONAL<<NOTE: VETERAN SUICIDE PREVENTION ANNUAL REPORT.

(a)38 NationalUSC Veteran1709B Suicidenote.>> PreventionNATIONAL AnnualVETERAN Report.--SUICIDE (1)PREVENTION InANNUAL general.--NotREPORT. later than 18 months after the date of the enactment of this Act, and not later than September 30 of each year thereafter, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees and publish on a publicly available website of the Department of Veterans Affairs a report to be known as the ``National Veteran Suicide Prevention Annual Report''.

(a) National Veteran Suicide Prevention Annual Report.-- (1) <<NOTE:

Public information.

Web posting.>> In general.-- Not later than 18 months after the date of the enactment of this Act, and not later than September 30 of each year thereafter, the Secretary of Veterans Affairs shall submit to the appropriate congressional committees and publish on a publicly available website of the Department of Veterans Affairs a report to be known as the ``National Veteran Suicide Prevention Annual Report''.

(i)[[Page Suicide138 ratesSTAT. of veterans disaggregated by age, gender, and race or ethnicity.

2756]] (i) Suicide rates of veterans disaggregated by age, gender, and race or ethnicity.

(V) veterans who are currently using, have recently used, or have never used programs or services provided by the Homeless Programs Office of[[Page the138 Department,STAT. including an examination of trends in suicide rates or deaths among veterans who made contact with such office but were denied or deemed ineligible for any such program or service;

2757]] of the Department, including an examination of trends in suicide rates or deaths among veterans who made contact with such office but were denied or deemed ineligible for any such program or service;

(C) Strategy and recommendations.-- (i) Initial report.--The initial report under paragraph (1) shall include a strategy and recommendations developed by the Secretary of Veterans Affairs, in collaboration with the Director of the Centers for Disease Control and Prevention, for-- (I) improving<<NOTE: data collection at the State and local levels to accurately capture suicide deaths of veterans;

Data.>> improving data collection at the State and local levels to accurately capture suicide deaths of veterans;

(III) improving<<NOTE: the timeliness of identification and analysis of suicide deaths of veterans by Federal agencies, including the Centers for Disease Control and Prevention, and the Department of Veterans Affairs;

Analysis.>> improving the timeliness of identification and analysis of suicide deaths of veterans by Federal agencies, including the Centers for Disease Control and Prevention, and the Department of Veterans Affairs;

(ii) Subsequent<<NOTE: reports.--Each report after the initial report under paragraph (1) shall include updates on actions taken to meet the strategy and recommendations developed under subparagraph (A).

Updates.>> Subsequent reports.-- Each report after the initial report under paragraph (1) shall include updates on actions taken to meet the strategy and recommendations developed under subparagraph (A).

(b) Independent Assessment of National Veteran Suicide Prevention Annual Report.-- (1)[[Page In138 general.--NotSTAT. later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into one or more contracts with a private sector entity described in paragraph (5) to conduct an independent assessment of the National Veteran Suicide Prevention Annual Report required under subsection (a).

2758]] (1) <<NOTE:

Contracts.>> In general.--Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall enter into one or more contracts with a private sector entity described in paragraph (5) to conduct an independent assessment of the National Veteran Suicide Prevention Annual Report required under subsection (a).

(3) Elements.--Each<<NOTE: assessment required under paragraph (1) shall analyze the following:

Analyses.>> Elements.--Each assessment required under paragraph (1) shall analyze the following:

and (B)[[Page has138 experienceSTAT. and proven outcomes in optimizing the accuracy and comprehensiveness of data collection and analysis related to suicide.

(c)2759]] Report(B) onhas Additionalexperience Benefits and Servicesproven Fromoutcomes Departmentin ofoptimizing Veterans Affairs to Prevent Veteran Suicide.-- (1) In general.--Not later than three years after the dateaccuracy of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and thecomprehensiveness House of Representativesdata andcollection publish on a publicly available website of the Department of Veterans Affairs a report that analyzes which benefits and servicesanalysis underrelated the laws administered by such Secretary, including such benefits and services furnished by the Veterans Benefits Administration, have the greatest impact on the prevention of suicide among veterans, including recommendations for potential expansion of services and benefits to reducesuicide. the number of veteran suicides.

(2)(c) AssessmentReport ofon solidAdditional startBenefits program.--Theand reportServices requiredFrom byDepartment paragraph (1) shall include an analysis of theVeterans effectivenessAffairs ofto thePrevent SolidVeteran StartSuicide.-- program(1) underIn sectiongeneral.-- 6320<<NOTE: of title 38, United States Code, on prevention of suicide among veterans.

Web posting.

Public information.

Recommenda- tions.>> Not later than three years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives and publish on a publicly available website of the Department of Veterans Affairs a report that analyzes which benefits and services under the laws administered by such Secretary, including such benefits and services furnished by the Veterans Benefits Administration, have the greatest impact on the prevention of suicide among veterans, including recommendations for potential expansion of services and benefits to reduce the number of veteran suicides.

(2) <<NOTE:

Analysis.>> Assessment of solid start program.-- The report required by paragraph (1) shall include an analysis of the effectiveness of the Solid Start program under section of title 38, United States Code, on prevention of suicide among veterans.

(2) Availability.--Not<<NOTE: later than two years after the date of the enactment of this Act, the Secretary shall make the toolkit developed under paragraph (1) available on a publicly available website of the Department of Veterans Affairs.

Deadline.

Public information.

Web posting.>> Availability.--Not later than two years after the date of the enactment of this Act, the Secretary shall make the toolkit developed under paragraph (1) available on a publicly available website of the Department of Veterans Affairs.

Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report, for each medical center or other relevant health care facility of the Department of Veterans Affairs, that includes-- (1) an identification of the physical infrastructure, including new facilities, renovations, remodels, leases, or other infrastructure, such medical center or health care facility requires to provide[[Page dental138 careSTAT. services to veterans eligible for such services under the laws administered by the Secretary;

and2760]] (2)provide andental analysis of the physical infrastructure such medical center or health care facilityservices wouldto require if a greater number of veterans became eligible for such dental care services pursuantunder to a modification of the laws administered by the Secretary.Secretary;

and (2) <<NOTE:

Analysis.>> an analysis of the physical infrastructure such medical center or health care facility would require if a greater number of veterans became eligible for such dental care services pursuant to a modification of the laws administered by the Secretary.

(a) In<<NOTE: General.--Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on the status of the oral health care programs of the Department of Veterans Affairs, that includes an assessment of-- (1) any issues with information technology programs, including Dental Record Manager Plus, that affect dental care staff of the Department;

Assessment.>> In General.--Not later than one year after the date of the enactment of this Act, the Comptroller General of the United States shall submit to the Committees on Veterans' Affairs of the Senate and the House of Representatives a report on the status of the oral health care programs of the Department of Veterans Affairs, that includes an assessment of-- (1) any issues with information technology programs, including Dental Record Manager Plus, that affect dental care staff of the Department;

SEC.[[Page 138 STAT.

2761]] SEC.

(b) Elements of Review.--The review required under subsection (a) shall include a review of-- (1) the<<NOTE: interfacility consult management guidance of the Veterans Health Administration that assists facilities described in subsection (a) in constructing a workflow for consults between such facilities;

Guidance.>> the interfacility consult management guidance of the Veterans Health Administration that assists facilities described in subsection (a) in constructing a workflow for consults between such facilities;

TITLE[[Page II--ECONOMIC138 OPPORTUNITYSTAT. MATTERS Subtitle A--Educational Assistance SEC.

2762]] TITLE II--ECONOMIC OPPORTUNITY MATTERS Subtitle A--Educational Assistance SEC.

TEMPORARY<<NOTE: EXPANSION OF ELIGIBILITY FOR MARINE GUNNERY SERGEANT JOHN DAVID FRY SCHOLARSHIP.

38 USC 3311 note.>> TEMPORARY EXPANSION OF ELIGIBILITY FOR MARINE GUNNERY SERGEANT JOHN DAVID FRY SCHOLARSHIP.

(b) Covered Individual Described.--An individual described in this subsection is an individual who is the child or spouse of a person-- (1) who<<NOTE: dies from a service-connected disability during the 120-day period immediately following the day on which the person was discharged or released from duty as a member of the Armed Forces (without regard to whether such duty was active duty);

Time period.>> who dies from a service-connected disability during the 120-day period immediately following the day on which the person was discharged or released from duty as a member of the Armed Forces (without regard to whether such duty was active duty);

and (2) a<<NOTE: quarter, semester, or term, as applicable, commencing-- (A) on or after August 1, 2025;

Time period.>> a quarter, semester, or term, as applicable, commencing-- (A) on or after August 1, 2025;

and (B)[[Page by138 strikingSTAT. ``under paragraph (1)'' and inserting ``for which the individual shall be solely liable to the United States for the amount of the overpayment for purposes of section 3685 of this title'';

2763]] (B) by striking ``under paragraph (1)'' and inserting ``for which the individual shall be solely liable to the United States for the amount of the overpayment for purposes of section 3685 of this title'';

or ``(B) does<<NOTE: not participate in such a program and the Secretary has waived the requirement under this paragraph with respect to the educational institution, and submits to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives notice of such waiver, because the Secretary determines that the educational institution-- ``(i) elects not to participate in such a program;

Waiver.

Notice.

Determination.>> does not participate in such a program and the Secretary has waived the requirement under this paragraph with respect to the educational institution, and submits to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives notice of such waiver, because the Secretary determines that the educational institution-- ``(i) elects not to participate in such a program;

or ``(iii) is<<NOTE: in the process of making a good- faith effort to submit an initial application for approval to participate in such a program, except that a waiver under this clause may not be provided for a period of longer than 36 months.''.

Time period.>> is in the process of making a good-faith effort to submit an initial application for approval to participate in such a program, except that a waiver under this clause may not be provided for a period of longer than 36 months.''.

``(5) The<<NOTE: educational institution agrees to, not later than days after any date on which such educational institution becomes subject to an action or event described in section 3673(e)(3) of this title, submit to the State approving agency, or the Secretary when acting in the role of a State approving agency, a notification of such action or event in such form and containing such information as the Secretary determines appropriate.''.

(b)Deadline. Additional Requirement for Approval of Nonaccredited Courses.-- (1) In general.--Section 3676(c) of such title is amended-- (A) by redesignating paragraphs (14) through (16) as paragraphs (15) through (17), respectively;

Notification.>> The educational institution agrees to, not later than 30 days after any date on which such educational institution becomes subject to an action or event described in section 3673(e)(3) of this title, submit to the State approving agency, or the Secretary when acting in the role of a State approving agency, a notification of such action or event in such form and containing such information as the Secretary determines appropriate.''.

[[Page 138 STAT.