(a) In general
The Secretary, in consultation with the Secretary of Health and Human Services, shall carry out a pilot program (in this section referred to as the pilot program ) to coordinate, navigate, and manage care and benefits for covered veterans.
(b) Purposes of pilot program
The purposes of the pilot program are as follows:
To improve access to health care services for covered veterans from the Department of Veterans Affairs and under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ).
To improve satisfaction with care received by covered veterans.
To improve quality of care received by covered veterans.
To lower costs to the Federal Government for care received by covered veterans.
To reduce gaps in care and duplication of services and expenses for covered veterans.
To improve care coordination for covered veterans, including coordination of patient information and medical records between providers and between the Department and the Centers for Medicare & Medicaid Services.
(c) Locations
The Secretary shall carry out the pilot program in not fewer than three but not more than five Veterans Integrated Service Networks with a significant number of covered veterans and geographic diversity, including—
locations that are in rural or highly rural areas, as determined through the use of the Rural-Urban Continuum codes of the Department of Agriculture; and
locations that are in medically underserved communities (as defined in section 799B of the Public Health Service Act ( 42 U.S.C. 295p )).
(d) Case manager
In carrying out the pilot program, the Secretary shall assign each covered veteran participating in the pilot program a case manager responsible for—
coordinating with the veteran, the primary care team of the veteran, and any relevant care coordinators already assisting the veteran to develop an individualized needs assessment for the veteran and, based on such assessment, a care coordination plan with defined treatment goals; and
navigating the systems of care under the laws administered by the Secretary and under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ).
(e) Use of existing models
In designing the pilot program, the Secretary may use existing models used by commercial health care programs to improve access, health outcomes, quality, and customer experience and lower per capita costs.
(f) Contracting with private sector entities
(1) In general
The Secretary, to the extent practicable, shall consider entering into contracts or agreements with private sector entities carrying out commercial health care programs for assistance in designing, implementing, and managing care and benefits under the pilot program, to include providing care coordination.
(2) Notification
If the Secretary determines that entering into contracts or agreements with private sector entities under paragraph (1) is not necessary or practicable, 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 notification of that determination;
a description of the steps, if any, the Secretary has taken to attempt to enter into a contract or an agreement with a private sector entity;
a justification for why the Secretary has determined that such contract or agreement is not necessary or practicable; and
a plan for how the Secretary will carry out the pilot program without entering into a contract or an agreement with a private sector entity, including through the use of employees of the Department of Veterans Affairs or other government agencies, nonprofit organizations, or other entities.
(g) Metrics
(1) In general
The Secretary shall track metrics under the pilot program, including the following:
The number of veterans participating in the pilot program, disaggregated by Veterans Integrated Service Network.
Reliance on health care services administered by the Secretary.
Reliance on health care services administered under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ).
Quality of care, including patient outcomes.
Cost of care.
Access to care, including under the designated access standards developed by the Secretary under section 1703B of title 38, United States Code.
Patient satisfaction.
Provider satisfaction.
Care coordination, including timely information sharing and medical documentation return.
(2) Elements
In tracking metrics under paragraph (1), the Secretary shall track information relating to—
whether care received by a covered veteran is related to a service-connected disability (as defined in section 101 of title 38, United States Code);
the priority group under section 1705(a) of title 38, United States Code, through which each covered veteran was enrolled in the system of annual patient enrollment of the Department of Veterans Affairs under such section;
the type of care and services provided to covered veterans; and
the demographics of covered veterans participating in the pilot program, including age.
(h) Supplement not supplant
The services provided under the pilot program shall supplement, not supplant, the services provided under the education program under section 121 of the VA MISSION Act of 2018 ( Public Law 115–182 ; 38 U.S.C. 1701 note).
(i) Duration
The Secretary shall carry out the pilot program for a three-year period beginning on the commencement of the pilot program.
(j) Reports
(1) Development, implementation, results, and design of pilot program
(A) In general
Not less frequently than biannually during the two-year period beginning on the date of the enactment of this Act, 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 development, implementation, results, and design of the pilot program, including information on the metrics tracked under subsection (g).
(B) Final design
One of the reports required under subparagraph (A) shall contain a description of the final design of the pilot program.
(2) Results of pilot program
(A) In general
Not later than one year after the submission of the final report under paragraph (1), and not less frequently than annually thereafter during 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 results of the pilot program.
(B) Final report
In the final report submitted under subparagraph (A), the Secretary shall include the recommendation of the Secretary for whether the pilot program should be extended or made permanent.
(k) Definitions
In this section:
(1) Covered veteran
The term covered veteran means a veteran who is enrolled in both the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) and the system of annual patient enrollment of the Department of Veterans Affairs under section 1705(a) of title 38, United States Code.
(2) Secretary
The term Secretary means the Secretary of Veterans Affairs.