(a) In general
Chapter 3 of title 38, United States Code, is amended by adding at the end the following new section:
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—
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—
reduce program expenditures; and
preserve or enhance the quality of care furnished to veterans;
give preference to models that improve the coordination, quality, and efficiency of health care services furnished under this title; and
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:
Bundled payment arrangements.
Preventive care initiatives.
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—
address a defined population for which there are demonstrated deficits in care leading to poor clinical outcomes or potentially avoidable expenditures; and
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—
changes in program expenditures;
changes in quality and outcomes of care for veterans; and
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 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;
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;
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;
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;
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;
a description of provider, stakeholder, and veteran experiences; and
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—
findings from the evaluation of such model;
updated findings under paragraph (1) with respect to such model;
an assessment of the fiscal impact of such model; and
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—
the Secretary determines such expansion is expected to—
reduce program expenditures without reducing quality of care; or
improve quality of care without increasing program expenditures; and
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—
(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:
(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—
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
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—
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);
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;
determine how the Secretary can improve access to care through the Veterans Community Care Program for veterans eligible for such care;
identify solutions to ease administrative, legislative, and regulatory burdens and improve efficiency in the Veterans Community Care Program;
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;
review how the Secretary—
identifies eligibility for and reviews, processes, and approves referrals for care under the Veterans Community Care Program;
authorizes the furnishing of services under the Veterans Community Care Program; and
receives, reviews, processes, and approves requests for payment from participating entities and providers furnishing services under the Veterans Community Care Program.
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—
a complete and unredacted list of all findings and recommendations from the review; and
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 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.
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—
in subsection (a)(2)(I), by adding at the end the following new clause:
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).
in subsection (d), by inserting or federally funded research and development center after private entity .