(a) Pilot program to improve care coordination for veterans from critical access hospitals and affiliated clinics
(1) In general
Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall commence a five-year pilot program to improve care coordination for eligible veterans who receive care from a critical access hospital or a provider-based rural health clinic affiliated with such hospital (in this section referred to as the pilot program ).
(2) Contracts, agreements, or other arrangements
(A) In general
In carrying out the pilot program, the Secretary shall enter into contracts, agreements, or other arrangements with facilities participating in the pilot program to reimburse critical access hospitals and affiliated clinics for outpatient health care and medical services provided to eligible veterans.
(B) Elements
The Secretary, in coordination with participating critical access hospitals, shall ensure that any contract, agreement, or other arrangement entered into under subparagraph (A) establishes criteria, as the Secretary considers appropriate, to ensure—
the provision of timely, safe, and high-quality health care services to participants in the pilot program, including through timely sharing of pertinent medical record and other information between medical facilities participating in the pilot program and medical facilities of the Department of Veterans Affairs;
the provision of health care services through the pilot program is in accordance with the medical benefits package of the Department;
no additional charges are imposed on veterans participating in the pilot program or the health care insurer of such veterans for any medical service for which payment is made by the Secretary;
appropriate reimbursement rates, including through the consideration of cost-based reimbursements; and
such other considerations as the Secretary considers appropriate.
(3) Locations
The Secretary shall ensure participation in the pilot program is open to all qualified facilities located in States that are designated by the Centers for Medicare & Medicaid Services as frontier States.
(4) Authorization for care
The Secretary shall provide eligible veterans opting to participate in the pilot program a one-year authorization from the Department to receive outpatient services at facilities participating in the pilot program.
(5) Outreach
(A) Eligible veterans
Not less frequently than annually during each year in which the pilot program is carried out, the Secretary shall conduct direct outreach to eligible veterans in areas in which the pilot program is carried out to notify such veterans of their ability to participate in the pilot program.
(B) Hospitals
The Secretary shall conduct direct outreach to critical access hospitals in areas in which the pilot program is carried out to notify those hospitals of their ability to participate in the pilot program.
(6) Staff
The Secretary shall ensure that each medical facility of the Department within the catchment area of a location in which the pilot program is carried out has sufficient dedicated staff to handle—
administrative and technical challenges that arise from the pilot program;
care coordination and follow up with the veteran and the facility participating in the pilot program after an episode of care; and
timely records return following an episode of care.
(7) Limitation
The Secretary may not extend the pilot program beyond the five-year period specified under subsection (a) or expand the pilot program to additional States or convert the pilot program into a permanent authority unless expressly authorized by a subsequent Act of Congress.
(8) Report
(A) In general
Not later than one year after the date of the enactment of this Act, and annually thereafter for the duration of the pilot program, 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 the pilot program.
(B) Elements
(i) In general
Each report required under subparagraph (A) shall contain the recommendation of the Secretary for the expansion or continuation of the pilot program.
(ii) Initial report
The initial report required under clause (i) shall contain—
(iii) Subsequent reports
Each report required under clause (i) after the initial report shall contain—
(9) Definitions
In this subsection:
(A) Critical access hospital
The term critical access hospital has the meaning given that term in section 1861(mm) of the Social Security Act ( 42 U.S.C. 1395x(mm) ).
(B) Eligible veteran
The term eligible veteran means a veteran—
enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705(a) of title 38, United States Code;
who has received care at a facility of the Department or in-network provider under the Veterans Community Care Program under section 1703 of such title during the previous two-year period;
who lives within 35 miles of a critical access hospital; and
who would be eligible for care or services under the Veterans Community Care Program.
(b) Action plan to address barriers to care for veterans living in rural areas
(1) In general
Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall develop and submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a comprehensive action plan to identify, address, and eliminate barriers to accessing care for veterans residing in rural, highly rural, and frontier areas.
(2) Elements
In developing the action plan required under paragraph (1), the Secretary shall—
consult with health care providers that provide care in the community under the laws administered by the Secretary, State Offices of Rural Health, Tribal health authorities, and other relevant stakeholders in rural, highly rural, and frontier areas as the Secretary determines appropriate;
assess barriers to care in the community for veterans residing in rural and highly rural areas, including challenges with respect to—
network adequacy;
provider participation;
geographic distance;
transportation;
information technology;
physical infrastructure;
outreach and understanding of eligibility for such care;
timeliness of referrals, authorization, and medical documentation exchange; and
any other matter the Secretary determines appropriate;
list specific and measurable strategies and actions to address the barriers and challenges assessed under subparagraph (B), to include the consideration of—
expanding participation in the Veterans Community Care Program under section 1703 of title 38, United States Code, among providers in rural, highly rural, and frontier areas;
physically locating health care facilities of the Department of Veterans Affairs within the same building or on the campuses of other health care facilities located in rural, highly rural, or frontier areas;
enhancing transportation assistance;
increasing reimbursement rates, including through cost-based reimbursements; and
improving coordination with State, Tribal, and local partners; and
assess legislative and regulatory barriers, if any, to addressing the barriers assessed under subparagraph (B).
(3) Implementation
Not later than 90 days after submitting the action plan under paragraph (1), the Secretary shall begin implementation of the plan and shall ensure full implementation not later than two years after the date of the enactment of this Act.
(c) Outreach
(1) Outreach to veterans
Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, through the Office of Rural Health (or successor office) and the Office of Integrated Veteran Care (or successor office), shall conduct outreach to veterans residing in rural, highly rural, and frontier areas regarding—
opportunities to seek care through facilities and programs of the Department of Veterans Affairs, including via telehealth, existing programs provided through grantees or contractors of the Department, Vet Centers (as defined in section 1712A of title 38, United States Code), and volunteer programs and services for transportation;
opportunities to seek care though the Veterans Community Care Program under section 1703 of title 38, United States Code;
opportunities to seek care at critical access hospitals with contracts, partnerships, or agreements with the Department of Veterans Affairs; and
any other matters the Secretary considers appropriate.
(2) Outreach to providers
Not later than one year after the date of the enactment of this Act, and annually thereafter, the Secretary of Veterans Affairs, through the Office of Rural Health (or successor office) and the Office of Integrated Veteran Care (or successor office), shall—
conduct outreach to health care facilities and critical access hospitals in rural areas regarding—
the Veterans Community Care program under section 1703 of title 38, United States Code, and the pilot program under subsection (a) of this section; and
any other matters the Secretary considers appropriate; and
seek to enter into contracts, partnerships, agreements, or other arrangements with health care facilities and critical access hospitals in rural areas.
(3) Critical access hospital defined
In this section, the term critical access hospital has the meaning given that term in section 1861(mm) of the Social Security Act ( 42 U.S.C. 1395x(mm) ).