[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4437 Introduced in Senate (IS)]

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118th CONGRESS
  2d Session
                                S. 4437

   To require the Secretary of Veterans Affairs to carry out a pilot 
   program to coordinate, navigate, and manage care and benefits for 
veterans enrolled in both the Medicare program and the system of annual 
       patient enrollment of the Department of Veterans Affairs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              June 3, 2024

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

_______________________________________________________________________

                                 A BILL


 
   To require the Secretary of Veterans Affairs to carry out a pilot 
   program to coordinate, navigate, and manage care and benefits for 
veterans enrolled in both the Medicare program and the system of annual 
       patient enrollment of the Department of Veterans Affairs.

    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 ``Coordinating Care for Senior 
Veterans and Wounded Warriors Act''.

SEC. 2. PILOT PROGRAM ON COORDINATION OF CARE BETWEEN DEPARTMENT OF 
              VETERANS AFFAIRS AND MEDICARE PROGRAM.

    (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:
            (1) To improve access to health care services for covered 
        veterans at medical facilities of the Department of Veterans 
        Affairs, from health care providers under the Veterans 
        Community Care Program under section 1703 of title 38, United 
        States Code, from health care providers with which the 
        Department has established a Veterans Care Agreement under 
        section 1703A of such title, and from health care providers 
        participating in the Medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.).
            (2) To improve outcomes of care received by covered 
        veterans.
            (3) To improve quality of care received by covered 
        veterans.
            (4) To lower costs of care received by covered veterans.
            (5) To eliminate gaps in care and duplication of services 
        and expenses for covered veterans.
            (6) To improve care coordination for covered veterans, 
        including coordination of patient information and medical 
        records between providers.
    (c) Administration.--
            (1) In general.--The Secretary shall carry out the pilot 
        program through the Center for Innovation for Care and Payment 
        of the Department of Veterans Affairs.
            (2) Locations.--The Secretary shall carry out the pilot 
        program in not less than three but not more than five Veterans 
        Integrated Service Networks with a large number of covered 
        veterans and varying degrees of urbanization, including--
                    (A) locations that are in rural or highly rural 
                areas, as determined through the use of the Rural-Urban 
                Commuting Areas coding system of the Department of 
                Agriculture; and
                    (B) locations that are medically underserved.
    (d) Case Manager.--
            (1) Assignment of 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 developing an individualized needs assessment for such 
        veteran and, based on such assessment, a care coordination plan 
        with defined treatment goals.
            (2) Accessing services.--A case manager assigned to a 
        covered veteran under paragraph (1) is responsible for 
        assisting such veteran in accessing services needed by such 
        veteran 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 shall, to the extent practicable, use existing models, 
including value-based care 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 shall, to the greatest 
        extent practicable, contract 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 
        contracting with private sector entities under paragraph (1) is 
        not 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) a notification of that determination;
                    (B) a description of the steps the Secretary has 
                taken to contract with a private sector entity;
                    (C) a justification for why the Secretary has 
                determined that contracting with a private sector 
                entity is not practicable; and
                    (D) a plan for how the Secretary will carry out the 
                pilot program without contracting 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:
                    (A) The number of veterans participating in the 
                pilot program, disaggregated by Veterans Integrated 
                Service Network.
                    (B) Reliance on health care services administered 
                by the Secretary.
                    (C) 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.).
                    (D) Quality of care, including patient outcomes.
                    (E) Cost of care.
                    (F) Access to care, including under the designated 
                access standards developed by the Secretary under 
                section 1703B of title 38, United States Code.
                    (G) Patient satisfaction.
                    (H) Provider satisfaction.
                    (I) 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--
                    (A) 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);
                    (B) 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;
                    (C) the type of care and services provided to 
                covered veterans; and
                    (D) the demographics of covered veterans 
                participating in the pilot program, including age.
    (h) Duration.--The Secretary shall carry out the pilot program for 
a 3-year period beginning on the commencement of the pilot program.
    (i) Reports.--
            (1) Development, implementation, results, and design of 
        pilot program.--
                    (A) In general.--Not less frequently than quarterly 
                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.--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.
            (3) Final report.--Not later than 180 days before the 
        termination 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 final report on the pilot program, which shall include the 
        recommendation of the Secretary for whether the pilot program 
        should be extended or made permanent.
    (j) 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.
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