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Requirement that Secretary notify veterans of eligibility for care or denial of request for care under Veterans Community Care Program

Title VI: Veterans’ Assuring Critical Care Expansions to Support Servicemembers · Subtitle A: Improvement of Veterans Community Care Program

Plain-language summaryAI

Veterans seeking care through the Veterans Community Care Program must be notified in writing within five days about their eligibility or denial of care, with options to opt out of these notifications. If care is denied, the notice must explain the reason and how to appeal, and periodic reminders of ongoing eligibility may be sent. The Department of Veterans Affairs must report annually to Congress for five years on how these notification requirements are being implemented.

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Section Text · Sec. 602.
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(a) In general

Section 1703(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:

(5)
(A)
(i)

Except as provided in clause (iii), the Secretary shall notify each covered veteran in writing of the eligibility of such veteran for care or services under this section as soon as possible but not later than five days after the date on which the Secretary is aware that the veteran is seeking care or services and is eligible for such care or services under this section.

(ii)

The Secretary is required to notify a covered veteran under clause (i) only at the start of an episode of care for such veteran.

(iii)

The Secretary shall allow a covered veteran to opt out of receiving notification under clause (i).

(B)

With respect to each covered veteran eligible for care or services under subsection (d), and consistent with subparagraph (A), the Secretary shall provide such veteran periodic reminders, as applicable and as the Secretary determines appropriate, of their ongoing eligibility under such subsection.

(C)

Any notification or reminder under this paragraph may be provided electronically.

(6)
(A)

If a request by a veteran for the Secretary to authorize care or services under this section is denied, except as provided in subparagraph (C), the Secretary shall notify the veteran in writing as soon as possible but not later than five days after the denial is made—

(i)

of the reason for the denial; and

(ii)

with instructions on how to appeal such denial using the clinical appeals process of the Veterans Health Administration.

(B)

If a denial under subparagraph (A) is due to the Secretary meeting the eligibility access standards under section 1703B(a) of this title, notice under such subparagraph shall include an explanation of how the Secretary met such standards.

(C)

The Secretary shall allow a covered veteran to opt out of receiving notification under subparagraph (A).

(D)

Any notification under this paragraph may be provided electronically.

(b) Reports to Congress

Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter for a period of five years, the Secretary of Veterans Affairs 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 implementation of the amendments made by subsection (a), including—

(1)

an assessment of the timeliness of the notifications required by those amendments;

(2)

a description of barriers to increasing the timeliness of those notifications; and

(3)

the number of veterans who opt out of receiving those notifications.