[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 5348 Introduced in Senate (IS)]

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117th CONGRESS
  2d Session
                                S. 5348

To amend title 38, United States Code, to expand access to the Veterans 
Community Care Program of the Department of Veterans Affairs to include 
 certain veterans seeking mental health or substance-use services and 
            toxic-exposed veterans, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           December 21, 2022

Mr. Daines (for himself and Ms. Lummis) introduced the following bill; 
which was read twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to expand access to the Veterans 
Community Care Program of the Department of Veterans Affairs to include 
 certain veterans seeking mental health or substance-use services and 
            toxic-exposed veterans, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Veteran Community Care 
Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) On June 6, 2018, the John S. McCain III, Daniel K. 
        Akaka, and Samuel R. Johnson VA Maintaining Internal Systems 
        and Strengthening Integrated Outside Networks Act of 2018 
        (Public Law 115-182) (in this section referred to as the ``VA 
        MISSION Act'') became law.
            (2) Congressional intent with the VA MISSION Act was to 
        reform and replace the program under section 101 of the 
        Veterans Access, Choice, and Accountability Act of 2014 (Public 
        Law 113-146; 38 U.S.C. 1701 note) to ensure access of veterans 
        to community health care providers.
            (3) The eligibility standards established by the VA MISSION 
        Act were not meant to be used to limit health care options for 
        veterans or to be applied to community providers, which would 
        result in reduced health care options.
            (4) Many veterans do not have access to a medical facility 
        of the Department of Veterans Affairs in their community and 
        each medical facility of the Department may not be able to 
        adequately address the specific health care needs of a 
        particular veteran.
            (5) It was the intent of Congress in the VA MISSION Act 
        that all medical services, including mental health treatments 
        and institutional extended care services for mental health, 
        were to be available to veterans in the community.
            (6) The Department is limiting access of veterans to 
        community care for mental health treatments.
            (7) Despite the best efforts of the Department, veteran 
        suicide remains at significant levels throughout the United 
        States.
            (8) No veteran should have to wait 30 days for mental 
        health services to be approved by the Department.
            (9) Telehealth appointments represent a valuable 
        complementary health care option for underserved veterans, but 
        do not offer the same quality of care as in-person visits to 
        facilities of the Department or in the community.

SEC. 3. EXPANSION OF VETERANS COMMUNITY CARE PROGRAM TO INCLUDE ACCESS 
              TO MENTAL HEALTH OR SUBSTANCE-USE SERVICES FOR VETERANS 
              UNABLE TO TIMELY ACCESS MENTAL HEALTH RESIDENTIAL 
              TREATMENT PROGRAMS.

    (a) In General.--Section 1703 of title 38, United States Code, is 
amended--
            (1) in subsection (d)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (D), by striking ``; 
                        or'' and inserting a semicolon;
                            (ii) in subparagraph (E), by striking the 
                        period at the end and inserting ``; or''; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(F) in the case of residential mental health or 
        substance-use services, the covered veteran--
                    ``(i) meets the criteria of the Department for 
                priority admission to a Mental Health Residential 
                Rehabilitation Treatment Program of the Department and 
                the Department is unable to accommodate such priority 
                admission; or
                    ``(ii) has contacted the Department to request such 
                services from a Mental Health Residential 
                Rehabilitation Treatment Program of the Department and 
                the Department is not able to furnish such services in 
                a manner than complies with the access standards of the 
                Department for specialty care provided under this 
                section by a health care provider specified in 
                subsection (c).''; and
                    (B) by adding at the end the following new 
                paragraph (4):
    ``(4) In the case of a covered veteran entitled to mental health or 
substance-use services under paragraph (1)(F), the Secretary shall 
ensure that referral of a veteran to an alternate Mental Health 
Residential Rehabilitation Treatment Program of the Department does not 
take precedence over timely access to such services under this section 
pursuant to such paragraph unless such referral is requested by the 
covered veteran.'';
            (2) by redesignating subsection (o) as subsection (p); and
            (3) by inserting after subsection (n) the following new 
        subsection (o):
    ``(o) Minimum Standards for Residential Mental Health or Substance-
Use Services.--(1) Subject to paragraph (2), in furnishing residential 
mental health or substance-use services to covered veterans pursuant to 
subsection (d)(1)(F), the Secretary shall ensure that programs or 
facilities providing such services under this section meet the 
following standards:
            ``(A) A treatment program or facility must be licensed and 
        accredited by a State for the provision of the services 
        provided.
            ``(B) A treatment program must be accredited under either 
        the Joint Commission Behavioral Health Standards or the 
        Behavioral Health Standards manual (residential treatment) of 
        the Commission on Accreditation of Rehabilitation Facilities, 
        or any successor standards or manual.
    ``(2) If a program or facility to which a covered veteran is to be 
referred pursuant to subsection (d)(1)(F) does not meet the standards 
specified under paragraph (1), the Secretary, acting through the 
director of the facility of the Department carrying out the referral--
            ``(A) shall consider an alternate program or facility; and
            ``(B) may waive such standards on an individual basis if no 
        other alternate program or facility is available or such waiver 
        is in the best interest of the veteran.''.
    (b) Modification of Access Standards.--Not later than 90 days after 
the date of the enactment of this Act, the Secretary of Veterans 
Affairs shall develop or amend existing access standards of the 
Department of Veterans Affairs to ensure that access to mental health 
care under the Veterans Community Care Program under section 1703 of 
title 38, United States Code, as amended by subsection (a), is not more 
restrictive than the access standards for specialty care under such 
section.

SEC. 4. REQUIREMENT TO PROVIDE CARE UNDER VETERANS COMMUNITY CARE 
              PROGRAM FOR TOXIC-EXPOSED VETERANS.

    Section 1703(d)(1) of title 38, United States Code, as amended by 
section 2(a)(1)(A), is further amended--
            (1) in subparagraph (E), by striking ``; or'' and inserting 
        a semicolon;
            (2) in subparagraph (F), by striking the period at the end 
        and inserting ``; or''; and
            (3) by adding at the end the following new subparagraph:
            ``(G) the covered veteran is a toxic-exposed veteran.''.

SEC. 5. PROHIBITION ON CERTAIN LIMITATIONS ON ACCESS OF VETERANS TO 
              CARE.

    Section 1703(n) of title 38, United States Code, is amended by 
adding at the end the following new paragraphs:
    ``(3) In applying wait times or access standards under this section 
for purposes of determining eligibility of a covered veteran for care 
or services under this section, the Secretary may not determine that 
the veteran is ineligible for such care or services due solely to the 
fact that health care providers specified in subsection (c) are unable 
to provide such care or services in compliance with such wait times or 
access standards.
    ``(4) If multiple options are available to a covered veteran for 
care or services under this section, the Secretary shall permit the 
veteran to elect the option that the veteran prefers.''.

SEC. 6. DEVELOPMENT OF COMMUNITY CARE METRICS.

    (a) In General.--Section 1703(m)(1) of title 38, United States 
Code, is amended by adding at the end the following new subparagraph:
    ``(C) The review submitted under subparagraph (A) shall include, 
for the year covered by the review, the following:
            ``(i) The number of instances of care or services 
        requested.
            ``(ii) The number of such requests that were approved.
            ``(iii) The number of such requests that were denied.
            ``(iv) The number of appeals under subsection (f) of such 
        requests that were denied, including the final decision of such 
        appeal.
            ``(v) The eligibility criteria under which each eligible 
        veteran has qualified for care or services under this section.
            ``(vi) Data with respect to the following:
                    ``(I) Requests for care or services relating to 
                mental health.
                    ``(II) Authorizations for emergency care, including 
                whether transportation for such care was required or 
                whether further care or a hospital stay was 
                required.''.
    (b) Application.--The amendment made by subsection (a) shall apply 
to each review conducted under subparagraph (A) of such section after 
the date of the enactment of this Act.

SEC. 7. LIMITATION ON MODIFICATION OF COMMUNITY CARE ACCESS STANDARDS.

    Any modification on or after the date of the enactment of this Act 
by the Secretary of Veterans Affairs of the conditions under which care 
is required to be provided under section 1703(d) of title 38, United 
States Code, either through a modification of the designated access 
standards under paragraph (1)(D) of such section, a modification of the 
criteria developed by the Secretary under paragraph (1)(E) of such 
section, or otherwise through regulation, shall not take effect until a 
joint resolution is enacted approving such modification to the 
conditions under which care is required to be provided under such 
section.
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