H.R. 9237

Take Care of America’s Veterans Act

Sponsor: Mike Bost

30 cosponsors
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Official summary

Written by the Congressional Research Service.

Take Care of America's Veterans Act

This bill addresses veterans’ benefits, health care, counseling, Department of Veterans Affairs (VA) personnel, VA infrastructure, and the Veterans Community Care Program (VCCP).

The bill modifies various compensation programs for veterans, including by (1) allowing concurrent receipt of disability compensation and military retired pay for certain retirees with a combat-related disability, (2) extending entitlement for various benefits and services to remarried surviving spouses, (3) increasing the rate of dependency and indemnity compensation, and (4) establishing a supplemental monthly allowance for certain disabled veterans.

The bill also addresses VA education and training benefits, including by (1) modifying which independent study programs are covered under veterans’ educational assistance benefits, (2) requiring Transition Assistance Program counseling to include a presentation about VA benefits, and (3) increasing the housing allowance rate for individuals pursuing apprenticeships.

The bill revises health care provisions, including by (1) expanding support and assistance provided to family caregivers, (2) extending the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, and (3) expanding the scope of VA mental health research.

Among other elements, the bill

  • revises VA disability ratings for sleep apnea and tinnitus;
  • expands eligibility for a memorial headstone or marker for the spouse, surviving spouse, child, or dependent of a veteran or member of the Armed Forces;
  • addresses the administration of the VCCP and codifies the eligibility standards;
  • establishes a standardized screening process for priority or routine admission to certain mental health care programs; and
  • addresses VA personnel, hiring, and infrastructure matters.

Text of the bill

Expand all

I Compensation

II Education and Economic Opportunity

III Health Care

IV Organization

V Memorial Affairs

VI Veterans’ Assuring Critical Care Expansions to Support Servicemembers

A Improvement of Veterans Community Care Program

B Mental Health Treatment Programs

C Staffing Matters

D Optimization of Workforce

E Veterans Infrastructure and Transformation

F Other Health Care Matters

Sec. 674. Modification of requirements for Center for Innovation for Care and Payment of the Department of Veterans Affairs and transfer of authority

(a) In general. Chapter 3 of title 38, United States Code, is amended by adding at the end the following new section:

Text this section adds to the law

326. Center for Innovation

(a) Establishment. There is established within the Department a Center for Innovation (in this section referred to as the Center).

(b) Purpose. The purpose of the Center is to test innovative payment and service delivery models to reduce program expenditures of the Department under chapter 17 of this title while preserving or enhancing the quality of care furnished to veterans and other eligible individuals.

(c) Identification and testing of models

(1) In general. The Center shall—

(A) identify and test health care payment and service delivery models under this title, including care from non-Department providers under subchapter I of chapter 17 of this title, that have the potential to—

(i) reduce program expenditures; and

(ii) preserve or enhance the quality of care furnished to veterans;

(B) give preference to models that improve the coordination, quality, and efficiency of health care services furnished under this title; and

(C) evaluate the effect of applying such models on program expenditures and quality outcomes under this title.

(2) Included models. The models identified and tested under paragraph (1) may include the following:

(A) Bundled payment arrangements.

(B) Preventive care initiatives.

(C) Chronic care coordination models.

(d) Selection of models

(1) In general. The Secretary, acting through the Center, shall select models to be tested under subsection (b) from among those that—

(A) address a defined population for which there are demonstrated deficits in care leading to poor clinical outcomes or potentially avoidable expenditures; and

(B) are expected to reduce program costs while preserving or enhancing the quality of care furnished to veterans.

(2) Criteria. In selecting models under paragraph (1), the Secretary shall apply criteria consistent with the model selection framework used in evidence-based criteria that the Secretary determines appropriate.

(e) Testing and evaluation

(1) In general. The Secretary shall design and test each model under this section in a manner that allows for the evaluation of—

(A) changes in program expenditures;

(B) changes in quality and outcomes of care for veterans; and

(C) other factors the Secretary determines relevant to care coordination, access, and equity.

(2) Evaluation. The Secretary shall evaluate each model under this section using scientifically valid methodologies, including control or comparison groups if practicable.

(f) Reporting

(1) Annual report. Not less frequently than annually, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on models being tested under this section and their preliminary results, including—

(A) a brief narrative description of the model explaining its intent and the proposed manner in which it is supposed to reduce expenditures and increase quality of or access to care for veterans;

(B) the number of veterans and providers participating in the model, broken down by demographics such as age, race or ethnicity, geographic location, and other characteristics as chosen by the Secretary;

(C) gross and net savings or increases to the medical services account of the Department, including in comparison to baseline budgetary assumptions in the absence of the model;

(D) an assessment of the utilization of the model, including the proportion of providers choosing to participate in the model and the proportion of veterans choosing to participate in the model, as the case may be;

(E) an assessment of quality of care and patient outcome as measured by discrete objective metrics, including changes to morbidity and mortality, changes to admission rates, changes to readmission rates, changes to population health metrics such as average blood pressure, A1C levels, body mass index, or other relevant health metrics, or other relevant clinical outcome metrics;

(F) a description of provider, stakeholder, and veteran experiences; and

(G) such other matters as the Secretary may consider relevant.

(2) Final report on models. Not later than 180 days after completing each model under this section, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a final report on such model, including—

(A) findings from the evaluation of such model;

(B) updated findings under paragraph (1) with respect to such model;

(C) an assessment of the fiscal impact of such model; and

(D) recommendations for expansion or termination of the use of such model.

(g) Expansion of successful models

(1) In general. Except as provided in paragraph (2), the Secretary may, through rulemaking, expand the duration and scope of a model tested under this section to the extent that—

(A) the Secretary determines such expansion is expected to—

(i) reduce program expenditures without reducing quality of care; or

(ii) improve quality of care without increasing program expenditures; and

(B) the Chief Financial Officer of the Department certifies that such expansion will maintain budget neutrality.

(2) Limitation. The Secretary shall not expand a model unless the results of the evaluation of the model under subsection (e) demonstrate that the requirements of paragraph (1) are satisfied.

(h) Cost neutrality and funding

(1) In general. Implementation or expansion of any model under this section shall be conducted in a manner that is cost-neutral to the Department over the duration of the use of the model, including administrative costs.

(2) Use of available amounts. The Secretary shall ensure that expenditures under this section are made from amounts otherwise available to the Department for medical services, community care, or medical support and compliance.

(i) Rule of construction. Nothing in this section shall be construed to authorize the Secretary to reduce the scope or amount of benefits under this title, or to impose additional eligibility requirements, except as may be necessary to carry out an approved model under this section.

(b) Conforming and clerical amendments

(1) Conforming repeal. Section 1703E of title 38, United States Code, is repealed.

(2) Conforming amendments

(A) Pilot program to improve administration of care under Veterans Community Care Program. Section 105(a) of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118–210; 38 U.S.C. 1703 note) is amended, in the matter preceding paragraph (1), by striking 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 and inserting Pursuant to section 326 of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation.

(B) Pilot program on consolidating approval process of Department of Veterans Affairs for covered dental care. Section 106(a) of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118–210; 38 U.S.C. 1703 note) is amended, in the matter preceding paragraph (1), by striking the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code and inserting the Center for Innovation established under section 326 of title 38, United States Code.

(C) Strategic plan on value-based health care system for Veterans Health Administration; pilot program. Section 107 of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (Public Law 118–210; 38 U.S.C. 1701 note) is amended—

(i) in subsection (a)(2)(A)(viii), by striking the Center for Innovation for Care and Payment of the Department under section 1703E of title 38, United States Code and inserting the Center for Innovation under section 326 of title 38, United States Code; and

(ii) in subsection (c)(1), by striking the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code and inserting “the Center for Innovation under section 326 of title 38, United States Code.

(3) Clerical amendments

(A) Chapter 17. The table of sections at the beginning of chapter 17 of title 38, United States Code, is amended by striking the item relating to section 1703E.

(B) Chapter 3. The table of sections at the beginning of chapter 3 of such title is amended by adding at the end the following new item:

Text this section adds to the law

326. Center for Innovation.

(c) Comptroller General report. Not later than 18 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report—

(1) on the efforts of the Center for Innovation of the Department of Veterans Affairs in fulfilling the objectives and requirements under section 326 of title 38, United States Code, as added by subsection (a); and

(2) containing such recommendations as the Comptroller General considers appropriate.

(d) Review of Veterans Community Care Program

(1) In general. Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs, acting through the Office of Management of the Department of Veterans Affairs, shall conduct a review of all aspects of the Veterans Community Care Program.

(2) Elements. The review required by paragraph (1) shall—

(A) identify proven management and payment best practices of the Federal Government used under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), and the TRICARE program (as defined in section 1072 of title 10, United States Code);

(B) determine what best practices, if any, identified under subparagraph (A) should be adopted and implemented by the Secretary, including those practices that would require legislative action before adoption and implementation;

(C) determine how the Secretary can improve access to care through the Veterans Community Care Program for veterans eligible for such care;

(D) identify solutions to ease administrative, legislative, and regulatory burdens and improve efficiency in the Veterans Community Care Program;

(E) identify improvements to the Veterans Community Care Program that can enhance the experience of veterans and participating entities and providers furnishing hospital care, medical services, and extended care services under the Veterans Community Care Program;

(F) review how the Secretary—

(i) identifies eligibility for and reviews, processes, and approves referrals for care under the Veterans Community Care Program;

(ii) authorizes the furnishing of services under the Veterans Community Care Program; and

(iii) receives, reviews, processes, and approves requests for payment from participating entities and providers furnishing services under the Veterans Community Care Program.

(G) assess such other factors as determined appropriate by the Secretary in consultation with Congress.

(3) Briefing and report

(A) Briefing. Periodically throughout the duration of the review required under paragraph (1), but not less frequently than quarterly, the Secretary shall brief the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives on the status and preliminary findings of such review.

(B) Report. Not later than 30 days after the conclusion of the review required under paragraph (1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a written report containing—

(i) a complete and unredacted list of all findings and recommendations from the review; and

(ii) any legislative, administrative, regulatory, policy, or other changes sought by the Secretary as a result of such findings.

(4) Veterans Community Care Program defined. In this subsection, the term Veterans Community Care Program means the Veterans Community Care Program under section 1703 of title 38, United States Code.

(e) Pilot programs

(1) In general. Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence carrying out the pilot programs described in paragraph (2) through the Center for Innovation established by section 326 of title 38, United States Code, as added by subsection (a), and the Office of Management of the Department of Veterans Affairs.

(2) Pilot programs described. The Secretary shall carry out the following pilot programs:

(A) A pilot program to test innovative payment models for the furnishing of preventive health services, as such term is defined in section 1701 of title 38, United States Code.

(B) A pilot program to test innovative payment models involving payment bundling for integrated care during an episode of care authorized under the Veterans Community Care Program under section 1703 of title 38, United States Code, to improve the coordination, quality, and efficiency of health care delivery under such program.

(f) Modification of independent assessments of health care delivery systems and management processes. Subsection 1704A of title 38, United States Code, is amended—

(1) in subsection (a)(2)(I), by adding at the end the following new clause:

Text this section adds to the law

(vi) To identify proven management and payment best practices of the Federal Government used under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), the Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.), and the TRICARE program (as defined in section 1072 of title 10).

; and

(2) in subsection (d), by inserting or federally funded research and development center after private entity.