Take Care of America’s Veterans Act

1709D. Prosthetic and Rehabilitative Items and Services Formulary

(a) In general. The Secretary shall establish a list of prosthetic and rehabilitative items and services, which may be referred to as the Prosthetic and Rehabilitative Items and Services Formulary or the Formulary, for purposes of furnishing medical services under section 1701(6)(F) of this title pursuant to section 1710 of this title.

(b) Requirements

(1) Input. In developing the Formulary, the Secretary shall solicit input from veterans and the public.

(2) Availability of items. The Secretary shall ensure that all items and services included in the Formulary are available at or through all facilities of the Department.

(3) Items To be included. In developing the Formulary, the Secretary shall rely on the best available evidence to identify which items and services should be included on the Formulary.

(c) Publication and communication

(1) Publication and update. The Secretary shall publish the Formulary on a website of the Department and shall update the Formulary periodically.

(2) Communication. The Secretary shall communicate to veterans the contents of the Formulary and information about how to appeal decisions regarding the provision of items and services on the Formulary.

(d) Contracts. The Secretary shall enter into such contracts as the Secretary considers necessary to support the availability of items and services included in the Formulary.

(e) Training. The Secretary shall ensure the availability of training on the Formulary for clinicians and other staff of the Department.

(f) Exceptions

(1) In general. The Secretary shall establish a process for clinicians of the Department to request, prescribe, and furnish prosthetic and rehabilitative items and services that are not included on the Formulary when medically necessary.

(2) Monitoring of non-Formulary items and services. The Secretary shall monitor requests and prescriptions for and the furnishing of prosthetic and rehabilitative items and services under paragraph (1)—

(A) to ensure that such items and services are being consistently and appropriately prescribed at all facilities of the Department; and

(B) to determine whether such items or services should be added to the Formulary.

(3) Prior authorization for non-formulary procurement. The Secretary shall establish a prior authorization process for the procurement of prosthetic and rehabilitative items that are not included on the Formulary or available through a national contract.

(4) Open market procurement. The Secretary shall ensure that procurement of items that are not included on the Formulary or available through a national contract is permitted only if a clinician determines the item is medically necessary.

(g) Consideration. In developing the Formulary, the Secretary shall consider how the approach of the Pharmacy Benefits Management Services of the Department for formulary management and medication safety can be adapted to support the efficient and effective administration of the Formulary.

(h) Enterprise procurement and ordering system

(1) In general. The Secretary shall implement an enterprise electronic ordering system for prosthetic and rehabilitative items and services furnished under this section.

(2) Systems elements. The system required under paragraph (1) shall—

(A) enable the automated ordering of items included on the Formulary;

(B) provide visibility of contract pricing and availability across all facilities of the Department;

(C) allow enterprise loading of nationally contracted products;

(D) provide procurement analytics to monitor compliance with national contracts and reduce open market purchasing; and

(E) contain all data elements required for the Federal Electronic Healthcare Record in a searchable format.

(3) Implementation. The Secretary shall ensure that the system required under paragraph (1) is implemented across all medical centers of the Department by not later than three years after the date of the enactment of this section.

(i) Program management

(1) In general. The Secretary shall ensure that the Prosthetic and Sensory Aids Service of the Department maintains adequate staffing to administer the Formulary and associated procurement programs.

(2) Staffing included. Staffing required under paragraph (1) shall include—

(A) dedicated program managers for major prosthetic product categories; and

(B) full-time clinical staff responsible for clinical evaluations and practice recommendations.

(j) Report to Congress. Not later than two years after the date of the enactment of this section, and annually thereafter, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report describing—

(1) rates of compliance by the Department with national prosthetic contracts;

(2) open market purchasing trends of the Department;

(3) utilization of the Formulary across facilities of the Department; and

(4) steps taken by the Department to improve enterprise procurement efficiency.