[Congressional Record Volume 168, Number 97 (Tuesday, June 7, 2022)]
[Senate]
[Pages S2837-S2838]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

  SA 5064. Mr. MORAN submitted an amendment intended to be proposed to 
amendment SA 5051 submitted by Mr. Tester (for himself and Mr. Moran) 
and intended to be proposed to the bill H.R. 3967, to improve health 
care and benefits for veterans exposed to toxic substances, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of title I, add the following:

                 Subtitle C--Other Health Care Matters

     SEC. 121. MODIFICATION TO STANDARDS FOR ACCESS TO HEALTH CARE 
                   FROM DEPARTMENT OF VETERANS AFFAIRS AND NON-
                   DEPARTMENT PROVIDERS.

       (a) In General.--Section 1703B of title 38, United States 
     Code, is amended--
       (1) by striking subsections (a) through (e) and inserting 
     the following new subsections:
       ``(a) Threshold Eligibility Standards for Access to 
     Community Care.--(1) A covered veteran may elect to receive 
     non-Department hospital care, medical services, or extended 
     care services through the Veterans Community Care Program 
     under section 1703 of this title pursuant to subsection 
     (d)(1)(D) of such section using the following eligibility 
     access standards:
       ``(A) With respect to primary care, mental health care, or 
     non-institutional extended care services, if the Department 
     cannot schedule an appointment for the covered veteran with a 
     health care provider of the Department--
       ``(i) within 30 minutes average driving time from the 
     residence of the veteran; and
       ``(ii) within 20 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran in consultation with the health care provider.
       ``(B) With respect to specialty care or specialty services, 
     if the Department cannot schedule an appointment for the 
     covered veteran with a health care provider of the 
     Department--
       ``(i) within 60 minutes average driving time from the 
     residence of the veteran; and
       ``(ii) within 28 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran in consultation with the health care provider.
       ``(2) For the purposes of determining the eligibility of a 
     covered veteran for care or services under paragraph (1), the 
     Secretary shall not take into consideration the availability 
     of telehealth appointments from the Department when 
     determining whether the Department is able to furnish such 
     care or services in a manner that complies with the 
     eligibility access standards under such paragraph.
       ``(b) Access to Care Standards for Community Care.--(1) 
     Subject to subsection (c), the Secretary shall meet the 
     following access to care standards when furnishing non-
     Department hospital care, medical services, or extended care 
     services to a covered veteran through the Veterans Community 
     Care Program under section 1703 of this title:
       ``(A) With respect to an appointment for primary care, 
     mental health care, or non-institutional extended care 
     services--
       ``(i) within 30 minutes average driving time from the 
     residence of the veteran unless a longer driving time has 
     been agreed to by the veteran; and
       ``(ii) within 20 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran.
       ``(B) With respect to an appointment for specialty care or 
     specialty services--
       ``(i) within 60 minutes average driving time from the 
     residence of the veteran unless a

[[Page S2838]]

     longer driving time has been agreed to by the veteran; and
       ``(ii) within 28 days of the date of request for such an 
     appointment unless a later date has been agreed to by the 
     veteran.
       ``(2) The Secretary shall ensure that--
       ``(A) health care providers specified under section 1703(c) 
     of this title are able to comply with the applicable access 
     to care standards under paragraph (1) for such providers; and
       ``(B) meeting such standards is reflected in the 
     contractual requirements of third-party administrators.
       ``(c) Waivers to Access to Care Standards for Community 
     Care Providers.--(1) A third-party administrator may request 
     a waiver to the requirement to meet the access to care 
     standards under subsection (b) if--
       ``(A)(i) the scarcity of available providers or facilities 
     in the region precludes the third-party administrator from 
     meeting those access standards; or
       ``(ii) the landscape of providers or facilities has changed 
     and certain providers or facilities are not available such 
     that the third-party administrator is not able to meet those 
     access standards; and
       ``(B) to address the scarcity of available providers or the 
     change in the provider or facility landscape, as the case may 
     be, the third-party administrator has contracted with other 
     providers or facilities that may not meet those access 
     standards, but are the currently available providers or 
     facilities most accessible to veterans within the region of 
     responsibility of the third-party administrator.
       ``(2) Any waiver requested by a third-party administrator 
     under paragraph (1) must be requested in writing and 
     submitted to the Office of Community Care of the Department 
     for approval by that office.
       ``(3) As part of any waiver request under paragraph (1), a 
     third-party administrator must include conclusive evidence 
     and documentation that the access to care standards under 
     subsection (b) cannot be met because of scarcity of available 
     providers or changes to the landscape of providers or 
     facilities.
       ``(4) In evaluating a waiver request under paragraph (1), 
     the Secretary shall consider the following:
       ``(A) The number and geographic distribution of eligible 
     health care providers available within the geographic area 
     and specialty referenced in the waiver request.
       ``(B) The prevailing market conditions within the 
     geographic area and specialty referenced in the waiver 
     request, which shall include the number and distribution of 
     health care providers contracting with other health care 
     plans (including commercial plans and the Medicare program 
     under title XVIII of the Social Security Act (42 U.S.C. 1395 
     et seq.)) operating in the geographic area and specialty 
     referenced in the waiver request.
       ``(C) Whether the service area is comprised of highly 
     rural, rural, or urban areas or some combination of such 
     areas.
       ``(D) How significantly the waiver request differs from the 
     access to care standards under subsection (b).
       ``(E) The rates offered to providers in the geographic area 
     covered by the waiver.
       ``(5) The Secretary shall not consider inability to 
     contract as a valid sole rationale for granting a waiver 
     under paragraph (1).
       ``(d) Calculation of Driving Times and Wait Times.--(1) For 
     purposes of calculating average driving time from the 
     residence of the veteran under subsections (a) and (b), the 
     Secretary shall use geographic information system software.
       ``(2) For purposes of calculating the wait time for a 
     veteran to schedule an appointment with the Department under 
     subsection (a), the Secretary shall measure from the date of 
     request for the appointment unless a later date has been 
     agreed to by the veteran in consultation with a health care 
     provider of the Department to the first next available 
     appointment date in the clinic schedule relevant to the 
     requested medical service.
       ``(e) Periodic Review of Access Standards.--Not later than 
     three years after the date of the enactment of the Sergeant 
     First Class Heath Robinson Honoring our Promise to Address 
     Comprehensive Toxics Act of 2022, and not less frequently 
     than once every three years thereafter, the Secretary shall--
       ``(1) conduct a review of the eligibility access standards 
     under subsection (a) and the access to care standards under 
     subsection (b) in consultation with--
       ``(A) such Federal entities as the Secretary considers 
     appropriate, including the Department of Defense, the 
     Department of Health and Human Services, and the Centers for 
     Medicare & Medicaid Services;
       ``(B) entities in the private sector; and
       ``(C) other entities that are not part of the Federal 
     Government; and
       ``(2) submit to the appropriate committees of Congress a 
     report on--
       ``(A) the findings of the Secretary with respect to the 
     review conducted under paragraph (1); and
       ``(B) such recommendations as the Secretary may have with 
     respect to the eligibility access standards under subsection 
     (a) and the access to care standards under subsection (b).'';
       (2) in subsection (f), by striking ``The Secretary'' and 
     inserting ``Compliance by Community Care Providers.--The 
     Secretary'';
       (3) by striking subsection (g) and inserting the following 
     new subsection (g):
       ``(g) Publication of Access Standards.--The Secretary shall 
     publish in the Federal Register and on a publicly available 
     internet website of the Department--
       ``(1) the eligibility access standards established under 
     subsection (a); and
       ``(2) the access to care standards established under 
     subsection (b).'';
       (4) in subsection (h)(1), by striking ``(1) Consistent 
     with'' and inserting ``Requests for Determinations.--(1) 
     Consistent with''; and
       (5) in subsection (i)--
       (A) by striking ``In this section'' and inserting 
     ``Definitions.--In this section''; and
       (B) by adding at the end the following new paragraphs:
       ``(3) The term `inability to contract', with respect to a 
     third-party administrator, means the inability of the third-
     party administrator to successfully negotiate and establish a 
     community care network contract with a provider or facility.
       ``(4) The term `third-party administrator' means an entity 
     that manages a provider network and performs administrative 
     services related to such network within the Veterans 
     Community Care Program under section 1703 of this title.''.
       (b) Prevention of Suspension of Veterans Community Care 
     Program.--Section 1703(a) of such title is amended by adding 
     at the end the following new paragraph:
       ``(4) Nothing in this section shall be construed to 
     authorize the Secretary to suspend the program established 
     under paragraph (1).''.
       (c) Establishment of Requirements for Documentation of 
     Postponement of Appointment Date.--Not later than 180 days 
     after the date of the enactment of this Act, the Secretary of 
     Veterans Affairs shall establish a process and requirements 
     for facilities of the Department of Veterans Affairs to 
     document the agreement of a veteran to postpone an 
     appointment as specified under section 1703B of title 38, 
     United States Code, as amended by subsection (a).

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