§ 1701. Definitions

Pub. L. 116–315, title III, § 3102, Jan. 5, 2021, 134 Stat. 5001, provided that: “(a) In General.—Not later than each of one year and two years after the date of the enactment of this Act [Jan. 5, 2021], the Secretary of Veterans Affairs shall provide for the conduct of a facility-level audit of the scheduling of appointments and the management of consultations for health care under the laws administered by the Secretary. “(b) Application.—“(1) First audit.—The first audit required under subsection (a) shall apply to each medical facility of the Department of Veterans Affairs. “(2) Second audit.—The second audit required under subsection (a) shall apply to only those medical facilities of the Department that are in need of corrective action based on the first audit, as determined by the Secretary. “(c) Elements.—Each audit conducted under subsection (a) shall include the following:“(1) With respect to each medical center of the Department covered by the audit, an assessment of any scheduling or consultation management issues at that medical center, including the following:“(A) An assessment of noncompliance with policies of the Veterans Health Administration relating to scheduling appointments and managing consultations. “(B) An assessment of the extent to which appointments or consultations are not timely processed. “(C) A description of any backlogs in appointments or consultations that are awaiting action. “(D) An assessment of whether consultations are appropriately processed. “(E) Data with respect to consultations as follows:“(i) Consultations that were scheduled within the request window. “(ii) Duplicate consultation requests. “(iii) Consultations that were discontinued. “(iv) Delays in consultations. “(v) Consultations that were not properly closed or discontinued, including a description of remediation attempts. “(F) A review for accuracy with respect to consultation management as follows:“(i) A review of the accuracy of the type of service, either administrative or clinical, that is inputted in the electronic health record. “(ii) A review of the accuracy of the type of consultation setting, either impatient [sic] or outpatient, that is inputted in the electronic health record. “(iii) A review of the appropriateness of the level of urgency of the consultation that is inputted in the electronic health record. “(iv) A review of any delayed or unresolved consultations. “(2) An identification of such recommendations for corrective action as the Secretary considers necessary, including additional training, increased personnel, and other resources. “(3) A certification that the director of each medical center of the Department covered by the audit is in compliance with the process and requirements established under section 3101(a) [set out as a note above] and such other requirements relating to the scheduling of appointments and management of consultations as the Secretary considers appropriate. “(4) With respect to referrals for health care between health care providers or facilities of the Department, a measurement of, for each medical facility of the Department covered by the audit—“(A) the period of time between—“(i) the date that a clinician of the Department determines that a veteran requires care from another health care provider or facility and the date that the referral for care is sent to the other health care provider or facility; “(ii) the date that the referral for care is sent to the other health care provider or facility and the date that the other health care provider or facility accepts the referral; “(iii) the date that the other health care provider or facility accepts the referral and the date that the appointment with the other health care provider or at the other facility is made; and “(iv) the date that the appointment with the other health care provider or at the other facility is made and the date of the appointment with the other health care provider or at the other facility; and “(B) any other period of time that the Secretary determines necessary to measure. “(5) With respect to referrals for non-Department health care originating from medical facilities of the Department, a measurement of, for each such facility covered by the audit—“(A) the period of time between—“(i) the date that a clinician of the Department determines that a veteran requires care, or a veteran presents to the Department requesting care, and the date that the referral for care is sent to a non-Department health care provider; “(ii) the date that the referral for care is sent to a non-Department health care provider and the date that a non-Department health care provider accepts the referral; “(iii) the date that a non-Department health care provider accepts the referral and the date that the referral to a non-Department health care provider is completed; “(iv) the date that the referral to a non-Department health care provider is completed and the date that an appointment with a non-Department health care provider is made; and “(v) the date that an appointment with a non-Department health care provider is made and the date that an appointment with a non-Department health care provider occurs; and “(B) any other period of time that the Secretary determines necessary to measure. “(d) Conduct of Audit by Third Party.—Each audit conducted under subsection (a) with respect to a medical facility of the Department shall be conducted by an individual or entity that is not affiliated with the facility. “(e) Transmittal to VHA.—Each audit conducted under subsection (a) shall be transmitted to the Under Secretary for Health of the Department so that the Under Secretary can—“(1) strengthen oversight of the scheduling of appointments and management of consultations throughout the Department; “(2) monitor national policy on such scheduling and management; and “(3) develop a remediation plan to address issues uncovered by those audits. “(f) Annual Report.—“(1) In general.—Not later than December 31 of each year in which an audit is conducted under subsection (a), 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 audit conducted during that year. “(2) Elements.—The Secretary shall include in each report required by paragraph (1)—“(A) the nationwide results of the audit conducted under subsection (a); “(B) the results of such audit with respect to each medical facility of the Department covered by such audit; “(C) an assessment of how the Department strengthened oversight of the scheduling of appointments and management of consultations at each such facility as a result of the audit; “(D) an assessment of how the audit informed the national policy of the Department with respect to the scheduling of appointments and management of consultations; and “(E) a description of any remediation plans to address issues raised by the audit that was completed.”

Establishment of Environment of Care Standards and Inspections at Department of Veterans Affairs Medical Centers

Pub. L. 116–315, title V, § 5103, Jan. 5, 2021, 134 Stat. 5027, provided that: “(a) In General.—The Secretary of Veterans Affairs shall establish a policy under which the environment of care standards and inspections at medical centers of the Department of Veterans Affairs include—“(1) an alignment of the requirements for such standards and inspections with the women’s health handbook of the Veterans Health Administration; “(2) a requirement for the frequency of such inspections; “(3) delineation of the roles and responsibilities of staff at each medical center who are responsible for compliance; “(4) the requirement that each medical center submit to the Secretary and make publicly available a report on the compliance of the medical center with the standards; and “(5) a remediation plan. “(b) Report.—Not later than 180 days after the date of the enactment of this Act [Jan. 5, 2021], 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 certifying in writing that the policy required by subsection (a) has been finalized and disseminated to all medical centers of the Department.”

Study on Staffing of Women Veteran Program Manager Program at Medical Centers of Department of Veterans Affairs and Training of Staff

Pub. L. 116–315, title V, § 5204, Jan. 5, 2021, 134 Stat. 5035, provided that: “(a) Study.—The Secretary of Veterans Affairs shall conduct a study on the use of the Women Veteran Program Manager program of the Department of Veterans Affairs to determine—“(1) if the program is appropriately staffed at each medical center of the Department; “(2) whether each medical center of the Department is staffed with a Women Veteran Program Manager; and “(3) whether it would be feasible and advisable to have a Women Veteran Program Ombudsman at each medical center of the Department. “(b) Report.—Not later than 270 days after the date of the enactment of this Act [Jan. 5, 2021], 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 study conducted under subsection (a). “(c) Training.—The Secretary shall ensure that all Women Veteran Program Managers and Women Veteran Program Ombudsmen receive the proper training to carry out their duties.”

Recording of Obligations

Pub. L. 116–260, div. FF, title XVI, § 1601, Dec. 27, 2020, 134 Stat. 3290, provided that: “Hereafter, subject to the availability of appropriations, the Secretary of Veterans Affairs shall record as an obligation of the United States Government amounts owed for hospital care or medical services furnished at non-Department facilities under title 38, United States Code, or Acts making appropriations for the Department of Veterans Affairs, on the date on which the Secretary approves: (i) a claim by a health care provider for payment or (ii) a voucher, invoice, or request for payment from a vendor for services rendered under a contract: Provided, That for any fiscal year in which an appropriation for the payment of hospital care or medical services furnished at non-Department facilities has been exhausted or has yet to be enacted, this title shall not provide the Secretary of Veterans Affairs with the authority to issue any new authorizations or orders for such care or such services in advance of such appropriation: Provided further, That this title shall take effect as if enacted on October 1, 2018: Provided further, That not later than 30 days after the date of enactment of this Act [Dec. 27, 2020], the Department of Veterans Affairs, in consultation with the Office of Management and Budget, shall submit a report to the President and the Congress, similar to the report required pursuant to 31 U.S.C. 1351, detailing how, in the absence of the enactment of this title, the expenditures or obligations would have exceeded the amount available in fiscal year 2019 and fiscal year 2020 in the Medical Community Care appropriation: Provided further, That the report required in the preceding proviso shall also include an explanation as to how the Department plans to avoid incurring obligations for the Medical Community Care appropriation in excess of its available budgetary resources in fiscal year 2021 and future fiscal years pursuant to the recording of obligations required by this title.”

Expanded Telehealth From Department of Veterans Affairs

Pub. L. 116–171, title VII, § 701, Oct. 17, 2020, 134 Stat. 825, provided that: “(a) In General.—The Secretary of Veterans Affairs shall enter into agreements, and expand existing agreements, with organizations that represent or serve veterans, nonprofit organizations, private businesses, and other interested parties for the expansion of telehealth capabilities and the provision of telehealth services to veterans through the award of grants under subsection (b). “(b) Award of Grants.—“(1) In general.—In carrying out agreements entered into or expanded under this section with entities described in subsection (a), the Secretary shall award grants to those entities. “(2) Locations.—To the extent practicable, the Secretary shall ensure that grants are awarded to entities that serve veterans in rural and highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture) or areas determined to be medically underserved. “(3) Use of grants.—“(A) In general.—Grants awarded to an entity under this subsection may be used for one or more of the following:“(i) Purchasing, replacing or upgrading hardware or software necessary for the provision of secure and private telehealth services. “(ii) Upgrading security protocols for consistency with the security requirements of the Department of Veterans Affairs. “(iii) Training of site attendants, including payment of those attendants for completing that training, with respect to— “(I) military and veteran cultural competence, if the entity is not an organization that represents veterans; “(II) equipment required to provide telehealth services; “(III) privacy, including the Health Insurance Portability and Accountability Act of 1996 [Pub. L. 104–191] privacy rule under part 160 and subparts A and E of part 164 of title 45, Code of Federal Regulations, or successor regulations, as it relates to health care for veterans; “(IV) scheduling for telehealth services for veterans; or “(V) any other unique training needs for the provision of telehealth services to veterans. “(iv) Upgrading existing infrastructure owned or leased by the entity to make rooms more conducive to telehealth care, including— “(I) additions or modifications to windows or walls in an existing room, or other alterations as needed to create a new, private room, including permits or inspections required in association with space modifications; “(II) soundproofing of an existing room; “(III) new electrical, telephone, or internet outlets in an existing room; or “(IV) aesthetic enhancements to establish a more suitable therapeutic environment. “(v) Upgrading existing infrastructure to comply with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.). “(vi) Upgrading internet infrastructure and sustainment of internet services. “(vii) Sustainment of telephone services. “(B) Exclusion.—Grants may not be used for the purchase of new property or for major construction projects, as determined by the Secretary. “(c) Agreement on Telehealth Access Points.—“(1) In general.—An entity described in subsection (a) that seeks to establish a telehealth access point for veterans but does not require grant funding under this section to do so may enter into an agreement with the Department for the establishment of such an access point. “(2) Adequacy of facilities.—An entity described in paragraph (1) shall be responsible for ensuring that any access point is adequately private, secure, clean, and accessible for veterans before the access point is established. “(d) Assessment of Barriers to Access.—“(1) In general.—Not later than 18 months after the date of the enactment of this Act [Oct. 17, 2020], the Secretary shall complete an assessment of barriers faced by veterans in accessing telehealth services. “(2) Elements.—The assessment required by paragraph (1) shall include the following:“(A) A description of the barriers veterans face in using telehealth while not on property of the Department. “(B) A description of how the Department plans to address the barriers described in subparagraph (A). “(C) Such other matters related to access by veterans to telehealth while not on property of the Department as the Secretary considers relevant. “(3) Report.—Not later than 120 days after the completion of the assessment required by 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 report on the assessment, including any recommendations for legislative or administrative action based on the results of the assessment.”

Partnerships to Provide Hyperbaric Oxygen Therapy to Veterans

Pub. L. 116–171, title VII, § 702(a), Oct. 17, 2020, 134 Stat. 827, provided that: “(1) Use of partnerships.—The Secretary of Veterans Affairs, in consultation with the Center for Compassionate Innovation within the Office of Community Engagement of the Department of Veterans Affairs, may enter into partnerships with non-Federal Government entities to provide hyperbaric oxygen treatment to veterans to research the effectiveness of such therapy. “(2) Types of partnerships.—Partnerships entered into under paragraph (1) may include the following:“(A) Partnerships to conduct research on hyperbaric oxygen therapy. “(B) Partnerships to review research on hyperbaric oxygen therapy provided to nonveterans. “(C) Partnerships to create industry working groups to determine standards for research on hyperbaric oxygen therapy. “(D) Partnerships to provide to veterans hyperbaric oxygen therapy for the purposes of conducting research on the effectiveness of such therapy. “(3) Limitation on federal funding.—Federal Government funding may be used to coordinate and administer the partnerships under this subsection but may not be used to carry out activities conducted under such partnerships.”

Review of Effectiveness of Hyperbaric Oxygen Therapy

Pub. L. 116–171, title VII, § 702(b), Oct. 17, 2020, 134 Stat. 827, provided that: “Not later than 90 days after the date of the enactment of this Act [Oct. 17, 2020], the Secretary [of Veterans Affairs], in consultation with the Center for Compassionate Innovation, shall begin using an objective and quantifiable method to review the effectiveness and applicability of hyperbaric oxygen therapy, such as through the use of a device approved or cleared by the Food and Drug Administration that assesses traumatic brain injury by tracking eye movement.”

Coverage of Testing for COVID–19: Application With Respect to Veterans

Pub. L. 116–127, div. F, § 6006(b), Mar. 18, 2020, 134 Stat. 207, provided that: “The Secretary of Veterans Affairs may not require any copayment or other cost sharing under chapter 17 of title 38, United States Code, for in vitro diagnostic products described in paragraph (1) of section 6001(a) [of Pub. L. 116–127, 42 U.S.C. 1320b–5 note] (or the administration of such products) or visits described in paragraph (2) of such section furnished during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act (42 U.S.C. 1320b–5(g)) beginning on or after the date of the enactment of this Act [Mar. 18, 2020].”

Plans To Improve Medical Facilities of the Department of Veterans Affairs

Pub. L. 115–407, title VI, § 602, Dec. 31, 2018, 132 Stat. 5380, provided that: “(a) Plans Required.—“(1) Plans of directors of medical facilities.—Not later than 90 days after the date of the enactment of this Act [Dec. 31, 2018], the Secretary of Veterans Affairs shall require each director of a medical facility of the Department of Veterans Affairs to submit to the director of the Veterans Integrated Service Network that covers the facility a plan to improve such facility. “(2) Plans of directors of veterans integrated service networks.—The Secretary shall require each director of a Veterans Integrated Service Network to submit to the Secretary, not later than 60 days after receiving all of the plans under paragraph (1), a plan, based on the plans received under paragraph (1), to improve the facilities within that Veterans Integrated Service Network in such a fashion that would improve the ability of all facilities within that network to provide the best and most efficient care to patients. “(b) Regular Reports.—The Secretary shall ensure that each director of a Veterans Integrated Service Network submits to the Secretary, not later than two years after the date of the enactment of this Act and not less frequently than once every two years thereafter, a report on the actions taken by the director to improve the facilities within that Veterans Integrated Service Network and what further such actions might be necessary. “(c) Sense of Congress on Use of Authorities to Investigate Medical Centers of the Department of Veterans Affairs.—It is the sense of Congress that the Secretary of Veterans Affairs should make full use of the authorities provided by section 2 of the Enhancing Veteran Care Act (Public Law 115–95; 38 U.S.C. 1701 note).”

Prevention of Certain Health Care Providers From Providing Non-Department Health Care Services to Veterans

Pub. L. 115–182, title I, § 108, June 6, 2018, 132 Stat. 1416, as amended by Pub. L. 117–328, div. U, title I, § 144, Dec. 29, 2022, 136 Stat. 5425, provided that: “(a) In General.—On and after the date that is 1 year after the date of the enactment of this Act [June 6, 2018], the Secretary of Veterans Affairs shall deny or revoke the eligibility of a health care provider to provide non-Department health care services to veterans if the Secretary determines that the health care provider—“(1) was removed from employment with the Department of Veterans Affairs due to conduct that violated a policy of the Department relating to the delivery of safe and appropriate health care; or “(2) violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license. “(b) Permissive Action.—On and after the date that is 1 year after the date of the enactment of this Act, the Secretary may deny, revoke, or suspend the eligibility of a health care provider to provide non-Department health care services if the Secretary determines such action is necessary to immediately protect the health, safety, or welfare of veterans and the health care provider is under investigation by the medical licensing board of a State in which the health care provider is licensed or practices. “(c) Suspension.—The Secretary shall suspend the eligibility of a health care provider to provide non-Department health care services to veterans if the health care provider is suspended from serving as a health care provider of the Department. “(d) Application.—The requirement to deny or revoke the eligibility of a health care provider to provide non-Department health care services to veterans under subsection (a) shall apply to any removal under paragraph (1) of such subsection or violation under paragraph (2) of such subsection that occurred on or after a date determined by the Secretary that is not less than five years before the date of the enactment of this Act. “(e) Comptroller General Report.—Not later than 2 years after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the implementation by the Secretary of this section, including the following:“(1) The aggregate number of health care providers denied or suspended under this section from participation in providing non-Department health care services. “(2) An evaluation of any impact on access to health care for patients or staffing shortages in programs of the Department providing non-Department health care services. “(3) An explanation of the coordination of the Department with the medical licensing boards of States in implementing this section, the amount of involvement of such boards in such implementation, and efforts by the Department to address any concerns raised by such boards with respect to such implementation. “(4) Such recommendations as the Comptroller General considers appropriate regarding harmonizing eligibility criteria between health care providers of the Department and health care providers eligible to provide non-Department health care services. “(f) Non-Department Health Care Services Defined.—In this section, the term ‘non-Department health care services’ means services—“(1) provided under subchapter I of chapter 17 of title 38, United States Code, at non-Department facilities (as defined in section 1701 of such title); “(2) provided under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note); “(3) purchased through the Medical Community Care account of the Department; or “(4) purchased with amounts deposited in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 [38 U.S.C. 1701 note].”

Veterans’ Education and Training Programs

Pub. L. 115–182, title I, § 121–123, June 6, 2018, 132 Stat. 1423, 1424, as amended by Pub. L. 115–251, title II, § 211(b)(1), Sept. 29, 2018, 132 Stat. 3176, provided that: “SEC. 121. EDUCATION PROGRAM ON HEALTH CARE OPTIONS.“(a) In General.—The Secretary of Veterans Affairs shall develop and administer an education program that teaches veterans about their health care options through the Department of Veterans Affairs. “(b) Elements.—The program under subsection (a) shall—“(1) teach veterans about—“(A) eligibility criteria for care from the Department set forth under sections 1703, as amended by section 101 of this title and 1710 of title 38, United States Code; “(B) priority groups for enrollment in the system of annual patient enrollment under section 1705(a) of such title [38 U.S.C. 1705(a)]; “(C) the copayments and other financial obligations, if any, required of certain individuals for certain services; and “(D) how to utilize the access standards and standards for quality established under sections 1703B and 1703C of such title; “(2) teach veterans about the interaction between health insurance (including private insurance, Medicare, Medicaid, the TRICARE program, the Indian Health Service, tribal health programs, and other forms of insurance) and health care from the Department; and “(3) provide veterans with information on what to do when they have a complaint about health care received from the Department (whether about the provider, the Department, or any other type of complaint). “(c) Accessibility.—In developing the education program under this section, the Secretary shall ensure that materials under such program are accessible—“(1) to veterans who may not have access to the internet; and “(2) to veterans in a manner that complies with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.). “(d) Annual Evaluation and Report.—“(1) Evaluation.—The Secretary shall develop a method to evaluate the effectiveness of the education program under this section and evaluate the program using the method not less frequently than once each year. “(2) Report.—Not less frequently than once each year, the Secretary shall submit to Congress a report on the findings of the Secretary with respect to the most recent evaluation conducted by the Secretary under paragraph (1). “(e) Definitions.—In this section:“(1) Medicaid.—The term ‘Medicaid’ means the Medicaid program under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.). “(2) Medicare.—The term ‘Medicare’ means the Medicare program under title XVIII of such Act (42 U.S.C. 1395 et seq.). “(3) Tricare program.—The term ‘TRICARE program’ has the meaning given that term in section 1072 of title 10, United States Code. “SEC. 122. TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE.“(a) Establishment of Program.—The Secretary of Veterans Affairs shall develop and implement a training program to train employees and contractors of the Department of Veterans Affairs on how to administer non-Department health care programs, including the following:“(1) Reimbursement for non-Department emergency room care. “(2) The Veterans Community Care Program under section 1703 of title 38, United States Code, as amended by section 101. “(3) Management of prescriptions pursuant to improvements under section 131. “(b) Annual Evaluation and Report.—The Secretary shall—“(1) develop a method to evaluate the effectiveness of the training program developed and implemented under subsection (a); “(2) evaluate such program not less frequently than once each year; and “(3) not less frequently than once each year, submit to Congress the findings of the Secretary with respect to the most recent evaluation carried out under paragraph (2). “SEC. 123. CONTINUING MEDICAL EDUCATION FOR NON-DEPARTMENT MEDICAL PROFESSIONALS.“(a) Establishment of Program.—“(1) In general.—The Secretary of Veterans Affairs shall establish a program to provide continuing medical education material to non-Department medical professionals. “(2) Education provided.—The program established under paragraph (1) shall include education on the following:“(A) Identifying and treating common mental and physical conditions of veterans and family members of veterans. “(B) The health care system of the Department of Veterans Affairs. “(C) Such other matters as the Secretary considers appropriate. “(b) Material Provided.—The continuing medical education material provided to non-Department medical professionals under the program established under subsection (a) shall be the same material provided to medical professionals of the Department to ensure that all medical professionals treating veterans have access to the same materials, which supports core competencies throughout the community. “(c) Administration of Program.—“(1) In general.—The Secretary shall administer the program established under subsection (a) to participating non-Department medical professionals through an internet website of the Department of Veterans Affairs. “(2) Curriculum and credit provided.—The Secretary shall determine the curriculum of the program and the number of hours of credit to provide to participating non-Department medical professionals for continuing medical education. “(3) Accreditation.—The Secretary shall ensure that the program is accredited in as many States as practicable. “(4) Consistency with existing rules.—The Secretary shall ensure that the program is consistent with the rules and regulations of the following:“(A) The medical licensing agency of each State in which the program is accredited. “(B) Such medical credentialing organizations as the Secretary considers appropriate. “(5) User cost.—The Secretary shall carry out the program at no cost to participating non-Department medical professionals. “(6) Monitoring, evaluation, and report.—The Secretary shall monitor the utilization of the program established under subsection (a), evaluate its effectiveness, and report to Congress on utilization and effectiveness not less frequently than once each year. “(d) Non-Department Medical Professional Defined.—In this section, the term ‘non-Department medical professional’ means any individual who is licensed by an appropriate medical authority in the United States and is in good standing, is not an employee of the Department of Veterans Affairs, and provides care to veterans or family members of veterans under the laws administered by the Secretary of Veterans Affairs.”

Establishment of Processes To Ensure Safe Opioid Prescribing Practices by Non-Department of Veterans Affairs Health Care Providers

Pub. L. 115–182, title I, § 131, June 6, 2018, 132 Stat. 1425, as amended by Pub. L. 115–251, title II, § 211(b)(2), Sept. 29, 2018, 132 Stat. 3176, provided that: “(a) Receipt and Review of Guidelines.—The Secretary of Veterans Affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the Opioid Safety Initiative of the Department of Veterans Affairs. “(b) Inclusion of Medical History and Current Medications.—The Secretary shall implement a process to ensure that, if care of a veteran by a covered health care provider is authorized under the laws administered by the Secretary, the document authorizing such care includes the available and relevant medical history of the veteran and a list of all medications prescribed to the veteran as known by the Department. “(c) Submittal of Medical Records and Prescriptions.—“(1) In general.—The Secretary shall, consistent with section 1703(a)(2)(A) of title 38, United States Code,, [sic] as amended by section 101 of this Act, and section 1703A(e)(2)(F) of such title, as added by section 102 of this Act, require each covered health care provider to submit medical records of any care or services furnished, including records of any prescriptions for opioids, to the Department in the timeframe and format specified by the Secretary. “(2) Responsibility of department for recording and monitoring.—In carrying out paragraph (1) and upon the receipt by the Department of the medical records described in paragraph (1), the Secretary shall—“(A) ensure the Department is responsible for the recording of the prescription in the electronic health record of the veteran; and “(B) enable other monitoring of the prescription as outlined in the Opioid Safety Initiative of the Department. “(3) 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 evaluating the compliance of covered health care providers with the requirements under this section. “(d) Use of Opioid Safety Initiative Guidelines.—“(1) In general.—If the Secretary determines that the opioid prescribing practices of a covered health care provider, when treating veterans, satisfy a condition described in paragraph (3), the Secretary shall take such action as the Secretary considers appropriate to ensure the safety of all veterans receiving care from that health care provider, including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the Secretary. “(2) Inclusion in contracts.—The Secretary shall ensure that any contracts, agreements, or other arrangements entered into by the Secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the Secretary specifically grant the authority set forth in paragraph (1) to such third parties and to the Secretary, as the case may be. “(3) Conditions for exclusion or limitation.—The Secretary shall take such action as is considered appropriate under paragraph (1) when the opioid prescribing practices of a covered health care provider when treating veterans—“(A) conflict with or are otherwise inconsistent with the standards of appropriate and safe care; “(B) violate the requirements of a medical license of the health care provider; or “(C) may place at risk the veterans receiving health care from the provider. “(e) Covered Health Care Provider Defined.—In this section, the term ‘covered health care provider’ means a non-Department of Veterans Affairs health care provider who provides health care to veterans under the laws administered by the Secretary of Veterans Affairs, but does not include a health care provider employed by another agency of the Federal Government.”

Competency Standards for Non-Department of Veterans Affairs Health Care Providers

Pub. L. 115–182, title I, § 133, June 6, 2018, 132 Stat. 1427, provided that: “(a) Establishment of Standards and Requirements.—The Secretary of Veterans Affairs shall establish standards and requirements for the provision of care by non-Department of Veterans Affairs health care providers in clinical areas for which the Department of Veterans Affairs has special expertise, including post-traumatic stress disorder, military sexual trauma-related conditions, and traumatic brain injuries. “(b) Condition for Eligibility To Furnish Care.—(1) Each non-Department of Veterans Affairs health care provider shall, to the extent practicable as determined by the Secretary or otherwise provided for in paragraph (2), meet the standards and requirements established pursuant to subsection (a) before furnishing care pursuant to a contract, agreement, or other arrangement with the Department of Veterans Affairs. Non-Department of Veterans Affairs health care providers furnishing care pursuant to a contract, agreement, or other arrangement shall, to the extent practicable as determined by the Secretary, fulfill training requirements established by the Secretary on how to deliver evidence-based treatments in the clinical areas for which the Department of Veterans Affairs has special expertise. “(2) Each non-Department of Veterans Affairs health care provider who enters into a contract, agreement, or other arrangement after the effective date identified in subsection (c) shall, to the extent practicable, meet the standards and requirements established pursuant to subsection (a) within 6 months of the contract, agreement, or other arrangement taking effect. “(c) Effective Date.—This section shall take effect on the day that is 1 year after the date of the enactment of this Act [June 6, 2018].”

Program on Establishment of Peer Specialists in Patient Aligned Care Team Settings Within Medical Centers of Department of Veterans Affairs

Pub. L. 115–182, title V, § 506, June 6, 2018, 132 Stat. 1477, as amended by Pub. L. 117–328, div. V, title IV, § 401(a), Dec. 29, 2022, 136 Stat. 5509, provided that: “(a) Program Required.—The Secretary of Veterans Affairs shall carry out a program to establish not fewer than two peer specialists in patient aligned care teams at medical centers of the Department of Veterans Affairs to promote the use and integration of services for mental health, substance use disorder, and behavioral health in a primary care setting. Each such peer specialist shall be a full-time employee whose primary function is to serve as a peer specialist and shall be in addition to all other employees of such medical center. “(b) Initial Timeframe for Establishment of Program.—The Secretary shall carry out the program at medical centers of the Department as follows:“(1) Not later than May 31, 2019, at not fewer than 15 medical centers of the Department. “(2) Not later than May 31, 2020, at not fewer than 30 medical centers of the Department. “(c) Initial Selection of Locations.—“(1) In general.—In establishing the program at initial locations, the Secretary shall select medical centers for the program as follows:“(A) Not fewer than five shall be medical centers of the Department that are designated by the Secretary as polytrauma centers. “(B) Not fewer than 10 shall be medical centers of the Department that are not designated by the Secretary as polytrauma centers. “(2) Considerations.—In selecting medical centers for the program under paragraph (1), the Secretary shall consider the feasibility and advisability of selecting medical centers in the following areas:“(A) Rural areas and other areas that are underserved by the Department. “(B) Areas that are not in close proximity to an active duty military installation. “(C) Areas representing different geographic locations, such as census tracts established by the Bureau of the Census. “(d) Timeframe for Expansion of Program; Selection of Additional Locations.—“(1) Timeframe for expansion.—The Secretary shall make permanent and expand the program to additional medical centers of the Department as follows:“(A) As of the date of the enactment of the STRONG Veterans Act of 2022 [Dec. 29, 2022], the Secretary shall make such program permanent at each medical center participating in the program on the day before such date of enactment. “(B) During the seven-year period following such date of enactment, the Secretary shall expand the program to an additional 25 medical centers per year until the program is carried out at each medical center of the Department. “(2) Selection of additional locations.—In selecting medical centers for the expansion of the program under paragraph (1)(B), until such time as each medical center of the Department is participating in the program by establishing not fewer than two peer specialists at the medical center, the Secretary shall prioritize medical centers in the following areas:“(A) Rural areas and other areas that are underserved by the Department. “(B) Areas that are not in close proximity to an active duty military installation. “(C) Areas representing different geographic locations, such as census tracts established by the Bureau of the Census. “(e) Considerations for Hiring Peer Specialists.—In carrying out the program at each medical center, the Secretary shall ensure that—“(1) the needs of female veterans are specifically considered and addressed; “(2) female peer specialists are hired and made available to support female veterans who are treated at each medical center. “(f) Engagement With Community Providers.—At each location selected under subsection (c), the Secretary shall consider ways in which peer specialists can conduct outreach to health care providers in the community who are known to be serving veterans to engage with those providers and veterans served by those providers. “(g) Reports.—“(1) Periodic reports.—“(A) In general.—Not later than one year after the date of the enactment of the STRONG Veterans Act of 2022 [Dec. 29, 2022], and annually thereafter for five years, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the program, including the expansion of the program under subsection (d)(1). “(B) Elements.—Each report under subparagraph (A) shall include, with respect to the one-year period preceding the submission of the report, the following:“(i) The findings and conclusions of the Secretary with respect to the program. “(ii) An assessment of the benefits of the program to veterans and family members of veterans. “(iii) An assessment of the effectiveness of peer specialists in engaging under subsection (f) with health care providers in the community and veterans served by such providers. “(iv) The name and location of each medical center where new peer specialists were hired. “(v) The number of new peer specialists hired at each medical center pursuant to this section and the total number of peer specialists within the Department hired pursuant to this section. “(vi) An assessment of any barriers confronting the recruitment, training, or retention of peer specialists. “(2) Final report.—Not later than one year after the Secretary determines that the program is being carried out at each medical center of the Department, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report notifying such committees of such determination.”

Department of Veterans Affairs Medical Scribe Pilot Program.

Pub. L. 115–182, title V, § 507, June 6, 2018, 132 Stat. 1479, as amended by Pub. L. 115–251, title II, § 211(b)(10), Sept. 29, 2018, 132 Stat. 3177, provided that: “(a) In General.—The Secretary of Veterans Affairs shall carry out a 2-year pilot program under which the Secretary shall increase the use of medical scribes at Department of Veterans Affairs medical centers. “(b) Locations.—The Secretary shall carry out the pilot program at the 10 medical centers of the Department as follows:“(1) At least four such medical centers located in rural areas. “(2) At least four such medical centers located in urban areas. “(3) Two such medical centers located in areas with need for increased access or increased efficiency, as determined by the Secretary. “(c) Medical Scribes.—“(1) Hiring.—Under the pilot program the Secretary shall—“(A) hire 20 new Department of Veterans Affairs term employees as medical scribes; and “(B) seek to enter into contracts with appropriate entities for the employment of 20 additional medical scribes. “(2) Distribution.—The Secretary shall assign four medical scribes to each of the 10 medical centers of the Department where the Secretary carries out the pilot program as follows:“(A) Two scribes shall be assigned to each of two physicians. “(B) Thirty percent of the scribes shall be employed in the provision of emergency care. “(C) Seventy percent of the scribes shall be employed in the provision of specialty care in specialties with the longest patient wait times or lowest efficiency ratings, as determined by the Secretary. “(d) Reports.—“(1) Reports to congress.—Not later than 180 days after the commencement of the pilot program required under this section, and every 180 days thereafter for the duration of the pilot program, the Secretary of Veterans Affairs shall submit to Congress a report on the pilot program. Each such report shall include each of the following:“(A) A separate analysis of each [of] the following with respect to medical scribes employed by the Department of Veterans Affairs and medical scribes performing Department of Veterans Affairs functions under a contract:“(i) Provider efficiency. “(ii) Patient satisfaction. “(iii) Average wait time. “(iv) The number of patients seen per day by each physician or practitioner. “(v) The amount of time required to hire and train an employee to perform medical scribe functions under the pilot program. “(B) Metrics and data for analyzing the effects of the pilot program, including an evaluation of the each of the [sic] elements under clauses (i) through (iv) of subparagraph (A) at medical centers who employed scribes under the pilot program for an appropriate period preceding the hiring of such scribes. “(2) Comptroller general report.—Not later than 90 days after the termination of the pilot program under this section, the Comptroller General of the United States shall submit to Congress a report on the pilot program. Such report shall include a comparison of the pilot program with similar programs carried out in the private sector. “(e) Definitions.—In this section:“(1) The term ‘medical scribe’ means an unlicensed individual hired to enter information into the electronic health record or chart at the direction of a physician or licensed independent practitioner whose responsibilities include the following:“(A) Assisting the physician or practitioner in navigating the electronic health record. “(B) Responding to various messages as directed by the physician or practitioner. “(C) Entering information into the electronic health record, as directed by the physician or practitioner. “(2) The terms ‘urban’ and ‘rural’ have the meanings given such terms under the rural-urban commuting codes developed by the Secretary of Agriculture and the Secretary of Health and Human Services. “(f) Funding.—The pilot program under this section shall be carried out using amounts otherwise authorized to be appropriated for the Department of Veterans Affairs. No additional amounts are authorized to be appropriated to carry out such program.”

Pilot Program for Health and Wellness Centers and Programs

Pub. L. 115–141, div. J, title II, § 252, Mar. 23, 2018, 132 Stat. 825, as amended by Pub. L. 116–94, div. F, title II, § 254, Dec. 20, 2019, 133 Stat. 2808, provided that: “During the period preceding October 1, 2022, the Secretary of Veterans Affairs may carry out a 2-year pilot program making grants to nonprofit veterans services organizations recognized by the Secretary in accordance with section 5902 of title 38, United States Code, to upgrade, through construction and repair, VSO community facilities into health and wellness centers and to promote and expand complementary and integrative wellness programs: Provided, That no single grant may exceed a total of $500,000: Provided further, That the Secretary may not provide more than 20 grants during the 2-year pilot program: Provided further, That the recipient of a grant under this section may not use the grant to purchase real estate or to carry out repair of facilities leased by the recipient or to construct facilities on property leased by the recipient: Provided further, That the Secretary ensures that the grant recipients use grant funds to construct or repair facilities located in at least 10 different geographic locations in economically depressed areas or areas designated as highly rural that are not in close proximity to Department of Veterans Affairs medical centers: Provided further, That the Secretary shall report to the Committees on Appropriations of both Houses of Congress no later than 180 days after enactment of this Act [Mar. 23, 2018], on the grant program established under this section.”

Investigation of Medical Centers of the Department of Veterans Affairs

Pub. L. 115–95, § 2, Dec. 20, 2017, 131 Stat. 2042, provided that: “(a) In General.—The Secretary of Veterans Affairs may contract with a nonprofit organization that accredits health care organizations and programs in the United States to investigate a medical center of the Department of Veterans Affairs to assess and report deficiencies of the facilities at such medical center. “(b) Authority of Directors.—“(1) In general.—Subject to coordination under paragraph (2), the Secretary shall delegate the authority under subsection (a) to contract for an investigation at a medical center of the Department to the Director of the Veterans Integrated Service Network in which the medical center is located or the director of such medical center. “(2) Coordination.—Before entering into a contract under paragraph (1), the Director of a Veterans Integrated Service Network or the director of a medical center, as the case may be, shall notify the Secretary of Veterans Affairs, the Inspector General of the Department of Veterans Affairs, and the Comptroller General of the United States for purposes of coordinating any investigation conducted pursuant to such contract with any other investigations that may be ongoing. “(c) Rule of Construction.—Nothing in this section may be construed—“(1) to prevent the Office of the Inspector General of the Department of Veterans Affairs from conducting any review, audit, evaluation, or inspection regarding a topic for which an investigation is conducted under this section; or “(2) to modify the requirement that employees of the Department assist with any review, audit, evaluation, or inspection conducted by the Office of the Inspector General of the Department.”

Faster Care for Veterans

Pub. L. 114–286, Dec. 16, 2016, 130 Stat. 1459, provided that: “SECTION 1. SHORT TITLE.“This Act may be cited as the ‘Faster Care for Veterans Act of 2016’. “SEC. 2. PILOT PROGRAM ESTABLISHING A PATIENT SELF-SCHEDULING APPOINTMENT SYSTEM.“(a) Pilot Program.—Not later than 120 days after the date of the enactment of this Act [Dec. 16, 2016], the Secretary of Veterans Affairs shall commence a pilot program under which veterans use an Internet website or mobile application to schedule and confirm medical appointments at medical facilities of the Department of Veterans Affairs. “(b) Selection of Locations.—The Secretary shall select not less than three Veterans Integrated Services Networks in which to carry out the pilot program under subsection (a). “(c) Contracts.—“(1) Authority.—The Secretary shall seek to enter into a contract using competitive procedures with one or more contractors to provide the scheduling capability described in subsection (a). “(2) Notice of competition.—Not later than 60 days after the date of the enactment of this Act, the Secretary shall issue a request for proposals for the contract described in paragraph (1). Such request shall be full and open to any contractor that has an existing commercially available, off-the-shelf online patient self-scheduling system that includes the capabilities specified in section 3(a). “(3) Selection.—Not later than 120 days after the date of the enactment of this Act, the Secretary shall award a contract to one or more contractors pursuant to the request for proposals under paragraph (2). “(d) Duration of Pilot Program.—“(1) In general.—Except as provided by paragraph (2), the Secretary shall carry out the pilot program under subsection (a) for an 18-month period. “(2) Extension.—The Secretary may extend the duration of the pilot program under subsection (a), and may expand the selection of Veterans Integrated Services Networks under subsection (b), if the Secretary determines that the pilot program is reducing the wait times of veterans seeking medical care and ensuring that more available appointment times are filled. “(e) Mobile Application Defined.—In this section, the term ‘mobile application’ means a software program that runs on the operating system of a cellular telephone, tablet computer, or similar portable computing device that transmits data over a wireless connection. “SEC. 3. CAPABILITIES OF PATIENT SELF-SCHEDULING APPOINTMENT SYSTEM.“(a) Minimum Capabilities.—The Secretary of Veterans Affairs shall ensure that the patient self-scheduling appointment system used in the pilot program under section 2, and any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs, includes, at a minimum, the following capabilities:“(1) Capability to schedule, modify, and cancel appointments for primary care, specialty care, and mental health. “(2) Capability to support appointments for the provision of health care regardless of whether such care is provided in person or through telehealth services. “(3) Capability to view appointment availability in real time. “(4) Capability to make available, in real time, appointments that were previously filled but later cancelled by other patients. “(5) Capability to provide prompts or reminders to veterans to schedule follow-up appointments. “(6) Capability to be used 24 hours per day, 7 days per week. “(7) Capability to integrate with the Veterans Health Information Systems and Technology Architecture of the Department, or such successor information technology system. “(b) Independent Validation and Verification.—“(1) Independent entity.—“(A) The Secretary shall seek to enter into an agreement with an appropriate non-governmental, not-for-profit entity with expertise in health information technology to independently validate and verify that the patient self-scheduling appointment system used in the pilot program under section 2, and any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs, includes the capabilities specified in subsection (a). “(B) Each independent validation and verification conducted under subparagraph (A) shall be completed as follows:“(i) With respect to the validation and verification of the patient self-scheduling appointment system used in the pilot program under section 2, by not later than 60 days after the date on which such pilot program commences. “(ii) With respect to any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs, by not later than 60 days after the date on which such system is deployed, regardless of whether such deployment is on a limited basis, but not including any deployments for testing purposes. “(2) GAO evaluation.—“(A) The Comptroller General of the United States shall evaluate each validation and verification conducted under paragraph (1). “(B) Not later than 30 days after the date on which the Comptroller General completes an evaluation under paragraph (1), the Comptroller General shall submit to the appropriate congressional committees a report on such evaluation. “(C) In this paragraph, the term ‘appropriate congressional committees’ means—“(i) the Committees on Veterans’ Affairs of the House of Representatives and the Senate; and “(ii) the Committees on Appropriations of the House of Representatives and the Senate. “(c) Certification.—“(1) Capabilities included.—Not later than December 31, 2017, the Secretary shall certify to the Committees on Veterans’ Affairs of the House of Representatives and the Senate that the patient self-scheduling appointment system used in the pilot program under section 2, and any other patient self-scheduling appointment system developed or used by the Department of Veterans Affairs as of the date of the certification, includes the capabilities specified in subsection (a). “(2) New systems.—If the Secretary develops or begins using a new patient self-scheduling appointment system that is not covered by a certification made under paragraph (1), the Secretary shall certify to such committees that such new system includes the capabilities specified in subsection (a) by not later than 30 days after the date on which the Secretary determines to replace the previous patient self-scheduling appointment system. “(3) Effect of capabilities not included.—If the Secretary does not make a timely certification under paragraph (1) or paragraph (2), the Secretary shall replace any patient self-scheduling appointment system developed by the Secretary that is in use with a commercially available, off-the-shelf online patient self-scheduling system that includes the capabilities specified in subsection (a). “SEC. 4. PROHIBITION ON NEW APPROPRIATIONS.“No additional funds are authorized to carry out the requirements of this Act. Such requirements shall be carried out using amounts otherwise authorized.”

Inspection Program for Kitchens and Food Service Areas at Department of Veterans Affairs Medical Facilities

Pub. L. 114–223, div. A, title II, § 251, Sept. 29, 2016, 130 Stat. 893, provided that: “(a) In General.—Not later than 90 days after the date of the enactment of this Act [Sept. 29, 2016], the Secretary of Veterans Affairs shall establish a program to conduct inspections of kitchens and food service areas at each medical facility of the Department of Veterans Affairs. Such inspections shall occur not less frequently than annually. The program’s goal is to ensure that the same standards for kitchens and food service areas at hospitals in the private sector are being met at kitchens and food service areas at medical facilities of the Department. “(b) Agreement.—“(1) In general.—The Secretary shall seek to enter into an agreement with the Joint Commission on Accreditation of Hospital Organizations under which the Joint Commission on Accreditation of Hospital Organizations conducts the inspections required under subsection (a). “(2) Alternate organization.—If the Secretary is unable to enter into an agreement described in paragraph (1) with the Joint Commission on Accreditation of Hospital Organizations on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate organization that—“(A) is not part of the Federal Government; “(B) operates as a not-for-profit entity; and “(C) has expertise and objectivity comparable to that of the Joint Commission on Accreditation of Hospital Organizations. “(c) Remediation Plan.—“(1) Initial failure.—If a kitchen or food service area of a medical facility of the Department is determined pursuant to an inspection conducted under subsection (a) not to meet the standards for kitchens and food service areas in hospitals in the private sector, that medical facility fails the inspection and the Secretary shall—“(A) implement a remediation plan for that medical facility within 72 hours; and “(B) Conduct [sic] a second inspection under subsection (a) at that medical facility within 14 days of the failed inspection. “(2) Second failure.—If a medical facility of the Department fails the second inspection conducted under paragraph (1)(B), the Secretary shall close the kitchen or food service area at that medical facility that did not meet the standards for kitchens and food service areas in hospitals in the private sector until full remediation is completed and all kitchens and food service areas at that medical facility meet such standards. “(3) Provision of food.—If a kitchen or food service area is closed at a medical facility of the Department pursuant to paragraph (2), the Director of the Veterans Integrated Service Network in which the medical facility is located shall enter into a contract with a vendor approved by the General Services Administration to provide food at the medical facility. “(d) Quarterly Reports.—Not less frequently than quarterly, the Under Secretary of Health shall submit to Congress a report on inspections conducted under this section, and their detailed findings and actions taken, during the preceding quarter at medical facilities of the Department.”

Mold Inspection Program for Department of Veterans Affairs Medical Facilities

Pub. L. 114–223, div. A, title II, § 252, Sept. 29, 2016, 130 Stat. 894, provided that: “(a) In General.—Not later than 90 days after the date of the enactment of this Act [Sept. 29, 2016], the Secretary of Veterans Affairs shall establish a program to conduct risk-based inspections for mold and mold issues at each medical facility of the Department of Veterans Affairs. Such facilities will be rated high, medium, or low risk for mold. Such inspections at facilities rated high risk shall occur not less frequently than annually, and such inspections at facilities rated medium or low risk shall occur not less frequently than biennially. “(b) Agreement.—“(1) In general.—The Secretary shall seek to enter into an agreement with the Joint Commission on Accreditation of Hospital Organizations under which the Joint Commission on Accreditation of Hospital Organizations conducts the inspections required under subsection (a). “(2) Alternate organization.—If the Secretary is unable to enter into an agreement described in paragraph (1) with the Joint Commission on Accreditation of Hospital Organizations on terms acceptable to the Secretary, the Secretary shall seek to enter into such an agreement with another appropriate organization that—“(A) is not part of the Federal Government; “(B) operates as a not-for-profit entity; and “(C) has expertise and objectivity comparable to that of the Joint Commission on Accreditation of Hospital Organizations. “(c) Remediation Plan.—If a medical facility of the Department is determined pursuant to an inspection conducted under subsection (a) to have a mold issue, the Secretary shall—“(1) implement a remediation plan for that medical facility within 7 days; and “(2) Conduct [sic] a second inspection under subsection (a) at that medical facility within 90 days of the initial inspection. “(d) Quarterly Reports.—Not less frequently than quarterly, the Under Secretary for Health shall submit to Congress a report on inspections conducted under this section, and their detailed findings and actions taken, during the preceding quarter at medical facilities of the Department.”

Improvement of Health Care Relating to Use of Opioids, Patient Advocacy, Complementary and Integrative Health, and Fitness of Providers