[House Report 119-576]
[From the U.S. Government Publishing Office]
119th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 119-576
======================================================================
VETERANS COMMUNITY CARE SCHEDULING IMPROVEMENT ACT
_______
March 30, 2026.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Bost, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 3482]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 3482) to amend title 38, United States Code, to
establish an online program through which an employee of the
Department of Veterans Affairs may schedule an appointment for
a covered veteran with a non-Department health care provider
under the Veterans Community Care Program, and for other
purposes, having considered the same, reports favorably thereon
with an amendment and recommends that the bill as amended do
pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 4
Background and Need for Legislation.............................. 5
Hearings......................................................... 7
Subcommittee Consideration....................................... 7
Committee Consideration.......................................... 7
Committee Votes.................................................. 8
Committee Oversight Findings..................................... 8
Statement of General Performance Goals and Objectives............ 8
Earmarks and Tax and Tariff Benefits............................. 8
Committee Cost Estimate.......................................... 8
Budget Authority and Congressional Budget Office Estimate........ 8
Federal Mandates Statement....................................... 12
Advisory Committee Statement..................................... 12
Applicability to Legislative Branch.............................. 12
Statement on Duplication of Federal Programs..................... 12
Section-by-Section Analysis of the Legislation................... 12
Changes in Existing Law Made by the Bill, as Reported............ 14
The amendment is as follows:
Strike out all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Community Care Scheduling
Improvement Act''.
SEC. 2. SCHEDULING OF APPOINTMENTS UNDER THE VETERANS COMMUNITY CARE
PROGRAM.
(a) Electronic Process.--Subsection (d) of section 3101 of the Johnny
Isakson and David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (Public Law 116-315; 38 U.S.C. 1701 note) is
amended to read as follows:
``(d) Electronic Process.--(1) The Secretary shall implement an
electronic process through which a scheduler of the Department, using
an information technology system, may schedule an appointment for
health care furnished by the Department or through the Veterans
Community Care Program, under section 1703 of this title, by a non-
Department health care provider.
``(2) The electronic process under this subsection shall allow a
scheduler, with regards to appointments described in--
``(A) either clause of subparagraph (A) of subsection (a)(1),
to view, search, and sort such appointments by type of care,
location, and date; and
``(B) clause (ii) of such subparagraph--
``(i) to schedule such an appointment;
``(ii) to provide referral and authorization
documents directly to a non-Department provider; and
``(iii) to perform any other function the Secretary
determines necessary.
``(3) The Secretary shall ensure that the electronic process allows a
scheduler to schedule an appointment for health care furnished by the
Secretary through a health care provider of the Department.
``(4) The Secretary shall implement the electronic process through an
existing agreement if practicable.
``(5) The Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives the following
regarding the electronic process:
``(A) Not later than 90 days after the Secretary makes a
determination under subparagraph (B)(iii) of paragraph (2), a
briefing regarding the functions the Secretary has determined
necessary.
``(B) Not later than six months after the date of the
enactment of Veterans Community Care Scheduling Improvement
Act, and semiannually thereafter during the following three
years, a report regarding operation of the electronic process
during both the semiannual period preceding the date of the
report and the cumulative period since the date of the
enactment of such Act. Such a report shall include the
following for each such period:
``(i) The number of non-Department health care
providers that participated in such electronic process,
disaggregated by--
``(I) category of hospital care or medical
services provided; and
``(II) medical center of the Department;
``(ii) The number of appointments scheduled pursuant
to the electronic process, disaggregated by--
``(I) category of hospital care or medical
services provided;
``(II) medical center of the Department; and
``(III) month.
``(iii) A comparison of the average wait time for
appointments scheduled through the electronic process
and through non-electronic methods, disaggregated by
medical center of the Department.
``(iv) The rates at which veterans cancelled
appointments scheduled through the electronic process.
``(v) The rates at which veterans did not appear for
appointments scheduled through the electronic
process.''.
(b) Implementation.--
(1) Date.--The Secretary of Veterans Affairs shall implement
the electronic process under subsection (d) of section 1703H of
such title, as added by this section, not later than two years
after the date of the enactment of this Act.
(2) Guidelines.--Not later than 90 days after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
establish guidelines. Such guidelines shall include the
following:
(A) Procedures for schedulers and other employees of
the Department involved in the scheduling of
appointments described in such section.
(B) A directive that employees described in
subparagraph (A) use the electronic process to the
extent practicable.
(C) A directive that employees described in
subparagraph (A), when scheduling an appointment for a
covered veteran (as such term is used in section 1703
of such title) for health care furnished by the
Secretary, inform such covered veteran of available
appointments though providers of the Department and
through providers under the Veterans Community Care
Program when eligible.
(D) Procedures for engaging with non-Department
health care providers in specialized cases.
(E) Standards regarding timeliness and accuracy.
(F) Escalation protocols for scheduling failures or
delays.
(3) Training.--Not later than 180 days after the date of the
enactment of this Act, the Secretary shall implement a
mandatory training program for employees described in paragraph
(2) regarding the guidelines under paragraph (2).
(4) Evaluation.--Not later than 60 days after the date of the
enactment of this Act, the Secretary shall prescribe
performance benchmarks and outcome-based metrics for the
electronic process under such section, including--
(A) time between a referral and a scheduled
appointment;
(B) patient satisfaction; and
(C) the percentage of appointments scheduled
exclusively through the electronic process.
(5) Outreach.--Not later than 90 days after the date of the
enactment of this Act, the Secretary shall plan and carry out
an outreach strategy to encourage non-Department of Veterans
Affairs health care providers that participate in the Veterans
Community Care Program to participate in the electronic process
under such subsection. Such outreach shall--
(A) include contacting each such provider during such
90 days;
(B) include seeking to enter into an agreement with
each such provider under which the provider shall
participate in the electronic process;
(C) include collaborating with State hospital
associations and rural health associations to promote
such participation;
(D) focus on providers in specialties or underserved
areas, as determined by the Secretary; and
(E) include the publication, on a publicly accessible
website of the Department, of information regarding--
(i) details of the electronic process;
(ii) how a provider may elect to participate
in the electronic process; and
(iii) a point of contact in the Department
regarding the electronic process.
(6) Oversight.--The Secretary shall submit to the Committees
on Veterans' Affairs of the Senate and House of
Representatives, with regards to the electronic process under
such subsection, the following:
(A) Not later than 30 days after the Secretary
establishes guidelines under paragraph (2) of this
subsection, a copy of such guidelines.
(B) Not later than 30 days after the Secretary
formulates the plan under paragraph (5) of this
subsection, a briefing on the outreach strategy under
such paragraph.
(C) Not later than 180 days after the date of the
enactment of this Act, the benchmarks and metrics
prescribed under paragraph (4).
(c) Expansion.--Not later than 90 days after the date of the
enactment of this Act, the Secretary shall submit to the Committees on
Veterans' Affairs of the Senate and House of Representatives a plan to
integrate the scheduling of appointments for health care furnished
through health care providers of the Department of Veterans Affairs
into the electronic process under subsection (d) of section 1703H of
such title. Such plan shall include the following elements:
(1) A timeline to implement such plan.
(2) Estimated costs to carry out such plan.
(3) Changes to policies and procedures of the Department the
Secretary determines necessary to implement such plan.
(d) Codification.--
(1) In general.--Section 3101 of such Act, as amended by
subsection (a), is transferred to subchapter I of chapter 17 of
title 38, United States Code, inserted after section 1703G, and
redesignated as section 1703H.
(2) Conforming amendments.--Section 1703H of such title, as
transferred and redesignated by this subsection, is amended--
(A) by striking any heading that is not a section
heading or subsection heading and conforming the
margins accordingly;
(B) by striking ``of title 38, United States Code''
both places it appears and inserting ``of this title'';
(C) in subsection (b)(1), by striking ``Not later
than one year after the date of the enactment of this
Act, the Secretary'' and inserting ``The Secretary'';
(D) in subsection (c)--
(i) in paragraph (1), in the matter preceding
subparagraph (A), by striking ``Not later than
180 days after the date of the enactment of
this Act, the Secretary'' and inserting ``The
Secretary''; and
(ii) in paragraph (2), by striking
subparagraphs (A) and (B) and inserting ``The
Secretary shall require each medical facility
of the Department to use the method or tool
described in paragraph (1).'';
(E) in the section enumerator, by striking ``sec.''
and inserting ``Sec. ''; and
(F) in the section heading--
(i) by striking ``process and requirements
for scheduling appointments for health care
from department of veterans affairs and non-
department health care.'' and inserting
``scheduling of appointments''; and
(ii) by conforming the typeface and
typestyle, including capitalization, to the
typeface and typestyle used in the section
heading of section 1703G of such title.
(3) Table of sections.--The table of sections at the
beginning of such chapter is amended by inserting, after the
item relating to section 1703G, the following new item:
``1703H. Scheduling of appointments.''.
SEC. 3. EXTENSION OF CERTAIN LIMITS ON PAYMENT OF PENSION.
Section 5503(d)(7) of title 38, United States Code, is amended by
striking ``January 31, 2033'' and inserting ``June 30, 2033''.
Purpose and Summary
H.R. 3482, the ``Veterans Community Care Scheduling
Improvement Act,'' was introduced by Representative Tom Barrett
of Michigan on May 19, 2025. The bill, as amended, would
establish an electronic process through which an employee of
the U.S. Department of Veterans Affairs (VA) may schedule an
appointment for a covered veteran with a non-VA health care
provider through the Veterans Community Care Program. By doing
so, this bill would modernize and simplify the appointment
scheduling process by adopting a unified process across VA for
veterans. This legislation would also authorize the External
Provider Scheduling (EPS) program in every VA medical center
and would direct VA to ensure that schedulers have real-time
access to both VA and non-VA provider information. It would
facilitate intelligent sorting by care type and location;
encourage employee use when possible; engage providers through
targeted outreach efforts; and provide Congress with regular
reports and updates to allow monitoring of the progress and
participation.
Background and Need for Legislation
Section 1: Short Title
This section would establish the short title as the
``Veterans Community Care Scheduling Improvement Act.''
Section 2: Scheduling of Appointments under the Veterans
Community Care Program
VA has long faced challenges in streamlining the scheduling
process for community health care appointments. Recognizing
this gap, VA began a pilot program to implement an External
Provider Scheduling Software-as-a-Service (SaaS) tool for the
purpose of determining what, where, and when appointments are
available with the ability for comparison against what is
available at VA medical centers. In testimony before the
Committee during the 119th Congress, VA officials emphasized
the importance of improving the patient scheduling experience,
adding that problems facing VA in terms of scheduling appear to
be technological and systems based.\1\
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\1\Hearing: Legis. Hearing Before the H. Comm. on Veterans' Affs.
Subcommittee. on Oversight and Investigations, 119th Cong. (2025)
(testimony of Cherri Waters, Acting Deputy Chief Info. Officer, Dep't
of Veterans Affairs.)
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The Committee recognizes that current scheduling processes
within VA pose structural barriers that can delay or complicate
veterans' access to timely, quality care. This is particularly
true when coordination with community providers is required.
Veterans often face challenges such as long travel times,
provider shortages, and administrative complexities that make
it difficult to schedule appointments or coordinate care across
VA and community providers. The Committee believes that
modernizing VA's scheduling and referral processes is necessary
to reduce these barriers and improve veterans' access to
healthcare.
This section would authorize VA to implement a more
modernized electronic process using an information technology
(IT) system. This IT system would give VA employees the ability
to schedule an appointment with a community care provider and
provide the referral and authorization documents without
needing to speak or correspond with the community care
provider. The Committee has closely watched VA's EPS program
from its initial deployment as a pilot to the nationwide
deployment achieved in December 2025. The Committee believes
the program has been successful in reducing the amount of time
veterans must wait to schedule an appointment with a community
provider and seeks to build upon this success.\2\ As such, this
section would require VA to continue its agreements with
vendors already in place but would give VA the flexibility to
add new functionalities as the program matures. If VA
identifies any new functionalities, this section would require
VA to notify Congress within 90 days of the identification of
that functionality.
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\2\Hearing: Ensuring Timely Access: Challenges in VA Scheduling
Before the H. Comm. on Veterans' Affairs. Subcommittee on Technology
Modernization, 118th Cong. 24 (2024) (testimony of Mark Hausmann, Exec.
Dir. for Access Transformation, Dep't of Veterans' Affairs.) (reporting
third quarter appointment timeliness data for FY24)
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Although the Committee believes that VA's EPS Program has
been successful, we are concerned that VA is not adequately
measuring and reporting on the program's performance. The
Committee believes that any considerable investment in an IT
system or electronic process requires enhanced Congressional
oversight and monitoring. Therefore, this section also would
include the metrics that the Committee believe are necessary to
demonstrate a positive return on the taxpayers' investment. The
Committee does not believe, however, that enhanced reporting
should continue forever. Therefore, this section would only
require reports to Congress for three years after enactment.
This section also includes several provisions that the
Committee believes would make VA more accountable. It would
require VA to issue written policies and procedures to VA
employees on how to best use the new process and how best to
engage with community providers. It would also require a
mandatory training program be developed within six months.
Further, this section would require a formal evaluation of the
program's performance. Currently, VA is not providing
information to Congress on how well its scheduling systems are
working or the degree to which any investment in technology
products is achieving key goals, such as reducing wait times or
increasing veteran satisfaction. The Committee believes these
metrics are necessary to ensure available taxpayer resources
are directed to areas where they will have the most impact.
This section also would include an outreach plan to ensure
VA is reaching enough community care providers. The Committee
believes that this new electronic process for scheduling
appointments cannot be successful without community care
providers agreeing to sign up for it. The Committee believes
that community care providers will want to allow VA to access
its scheduling grids to better serve their patients who are
veterans if they can be convinced that working with VA will not
turn into a bureaucratic nightmare. The Committee believes the
required outreach plan must contain adequate information for
community providers to know how best to work with VA on
scheduling matters and who to contact should they have
problems.
There are several disparate scheduling systems in place
today. Every Congress since the passage of the 2018 MISSION Act
has required VA to improve its scheduling processes through
legislation. Instead of an enterprise scheduling system
overhaul, VA has set up separate programs and systems for
scheduling in the community than it uses to schedule
appointments at VA operated clinics. The Committee understands
that separate systems are necessary because VA's legacy
electronic health record (EHR) is not capable of integrating
scheduling even within its own clinics, much less than those in
community. We do believe, however, that this new process should
be considered as a viable option to integrated scheduling.
Therefore, this section would require VA to submit a plan to
Congress on how this could or could not be accomplished.
By updating the scheduling system to reflect modern
technological capabilities, the Committee believes that this
bill would improve coordination of care between VA and non-VA
providers, streamline the scheduling process, and help ensure
veterans receive timely access to needed healthcare in the
communities where they live.
Section 3: Extension of Certain Limits on Payments of Pension
Under current law (38 U.S.C. Sec. 5503(d)), the amount of
VA pension paid to a veteran with no spouse or child, a
veteran's surviving spouse with no child, or a veteran's child
who is admitted to a VA or Medicaid sponsored nursing facility
is capped at $90 a month. This section would cover the costs of
the other sections of this bill by extending this pension
limitation by five months to June 30, 2033. Because they
receive government sponsored care in a nursing home, these
pension beneficiaries do not require the full amount of pension
to cover their cost of living.
The Committee believes this short-term extension of the
current limit on pension payments would be a reasonable way to
cover the costs associated with the other sections of this
bill.
Hearings
On June 11, 2025, the Committee on Veterans' Affairs
Subcommittee on Oversight & Investigations held a legislative
hearing on H.R. 3482 and other bills that were pending before
the subcommittee.
The following witnesses testified:
Ms. Cherri Waters, Acting Deputy Chief Information
Officer; Executive Director, Health Portfolio, Product
Delivery Services, Office of Information and
Technology, U.S. Department of Veterans Affairs; Ms.
Laura Duke, Chief Financial Officer, Veterans Health
Administration, U.S. Department of Veterans Affairs;
Dr. Toni Phillips, Chief Nurse Informatics Officer,
Electronic Health Record, Management Information
Office, U.S. Department of Veterans Affairs; Dr.
Jennifer McDonald, Director, Community Care Division,
Office of Audits and Evaluations, Office of the
Inspector General, U.S. Department of Veterans Affairs;
Dr. Edward O'Bryan, MD, MBA, CPE, Chief, Veterans and
Corrections ICCE, Associate Professor of Medicine,
Medical University of South Carolina; Mr. Cole T. Lyle,
Director of the Veterans Affairs & Rehabilitation
(VA&R) Division, The American Legion; Mr. Cody Carbone,
Chief Executive Officer, The Digital Chamber.
Subcommittee Consideration
On February 12, 2026, the Subcommittee on Oversight and
Investigations was discharged from further consideration of
H.R. 3482.
Committee Consideration
On February 12, 2026, the Full Committee met in open markup
session, a quorum being present, to consider H.R. 3482. During
consideration of the bill, the following amendments were
considered:
An amendment in the nature of a substitute to H.R. 3482 was
offered by Representative Nikki Budzinski of Illinois that
would expand the purpose of the information technology system
to streamline the scheduling process, and include training,
evaluation, and oversight mechanisms. The amendment was agreed
to by voice vote.
An amendment to an amendment in the nature of a substitute
to H.R. 3482 was offered by Representative Tom Barrett of
Michigan that would fully offset the cost of the bill. The
amendment was agreed to by voice vote.
A motion by Ranking Member Mark Takano of California to
report H.R. 3482, as amended, favorably to the House of
Representatives, was agreed to by voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, no recorded votes were taken on
amendments or in connection with ordering H.R. 3482, as
amended, reported to the House.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives of H.R. 3482, as amended, are to reduce
administrative burden of scheduling appointments, reduce the
time for veterans to schedule a community care appointment, and
improve veteran satisfaction with the scheduling process.
Earmarks and Tax and Tariff Benefits
H.R. 3482, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
The Committee adopts as its own the cost estimate on H.R.
3482, as amended, prepared by the Director of the Congressional
Budget Office.
Budget Authority and Congressional Budget Office
Cost Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
for H.R. 3482, as amended, provided by the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
of 1974:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The bill would:
Require the Department of Veterans Affairs
(VA) to implement an electronic system to schedule
appointments for care furnished by VA or through the
Veterans Community Care Program
Direct VA to establish guidelines and
provide training for use of the system
Require VA to conduct outreach to community
providers and report to the Congress on system
performance
Extend the reduction of pensions that VA
pays to veterans and survivors residing in Medicaid
nursing homes
Estimated budgetary effects would mainly stem from:
Developing guidelines, providing training,
conducting outreach
Reducing pension payments
Bill summary: H.R. 3482 would require the Department of
Veterans Affairs (VA) to implement an electronic system that
enables schedulers to make appointments for health care from VA
providers and care furnished through the Veterans Community
Care Program. The bill also would require the department to
establish guidelines, provide training, and conduct outreach on
that system. Finally, the bill would extend a temporary
limitation on certain pension payments through June 30, 2033.
Estimated Federal cost: The estimated budgetary effects of
H.R. 3482 are shown in Table 1. The costs of the legislation
fall within budget functions 550 (health) and 700 (veterans
benefits and services).
TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 3482
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
--------------------------------------------------------------------------------------------
2026- 2026-
2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2031 2036
--------------------------------------------------------------------------------------------------------------------------------------------------------
INCREASES OR DECREASES (-) IN DIRECT SPENDING
Estimated Budget Authority................................. * * * * 1 * * -5 * * * 1 -4
Estimated Outlays.......................................... * * * * 1 * * -5 * * * 1 -4
INCREASES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization................................... * 1 * * * * * 1 * * 1 1 3
Estimated Outlays.......................................... * 1 * * * * * 1 * * 1 1 3
--------------------------------------------------------------------------------------------------------------------------------------------------------
* = between zero and $500,000.
Basis of estimate: For this estimate, CBO assumes that H.R.
3482 will be enacted in fiscal year 2026 and that outlays will
follow historical spending patterns for affected programs.
Provisions that affect direct spending and spending subject
to appropriation: The bill would require VA to implement an
electronic system that allows schedulers to arrange
appointments for care furnished by VA or through the Veterans
Community Care Program. It also would require the department to
establish guidelines governing the use of the system, provide
training for relevant staff, and conduct outreach to community
providers to encourage their participation in the system.
According to VA, the department is developing similar
information technology capabilities to support appointment
scheduling that would meet the requirements of the bill.
Developing guidelines and providing training on the system to
schedulers, andconducting outreach to community care providers
would increase VA's workload by the equivalent of two full-time
employees, CBO estimates. Annual compensation, benefits, and operating
expenses would average about $170,000 per employee. CBO estimates that,
in total, implementing those requirements would cost $4 million over
the 2026-2036 period.
VA uses several appropriation accounts to pay for the costs
of health care, disability claims processing, medical research,
and information technology (IT) modernization. One of those
accounts, the Toxic Exposures Fund (TEF), is a mandatory
appropriation that can be used to pay for some of the costs of
those activities if they support veterans who were exposed to
toxic substances or environmental hazards.\1\ The other
accounts are discretionary appropriations. H.R. 3482 would
affect IT modernization that benefits veterans with and without
toxic exposures; therefore, enacting the bill would increase
direct spending from the TEF as well as spending subject to
appropriation. CBO allocates the estimated costs of legislation
between the TEF and the discretionary appropriation accounts on
the basis of the portion of all funding for those activities
that are projected, in CBO's baseline, to come from the TEF.
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\1\For additional information about estimated spending from the
TEF, see Congressional Budget Office, ``Toxic Exposures Fund--February
2026 Baseline'' (February 2026), https://tinyurl.com/5c2kp8fs, and How
CBO Would Estimate the Effects of Future Authorizing Legislation on
Spending From the Toxic Exposures Fund (December 2022), www.cbo.gov/
publication/58843.
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On that basis, CBO estimates that over the 2026-2036
period, implementing the consultation and notification
requirements of H.R. 3482 would increase direct spending by $1
million and spending subject to appropriation by $3 million.
Direct spending: In addition to requiring VA to develop
guidelines for the electronic scheduling system, provide
training, and conduct outreach to community providers, enacting
H.R. 3482 would affect direct spending by extending a statutory
limitation on VA pension payments. In total, enacting the bill
would decrease net direct spending by $4 million over the 2026-
2036 period (see Table 2).
Pensions and Medicaid. Under current law, VA reduces
pension payments to veterans and survivors who reside in
Medicaid nursing homes to $90 per month. That required
reduction expires January 31, 2033. H.R. 3482 would extend that
reduction for 5 months, through June 30, 2033. CBO estimates
that extending that requirement would reduce VA benefits by $2
million per month. As a result of that reduction in
beneficiaries' income, Medicaid would pay more of the cost of
their care, increasing spending for that program by $1 million
per month. Thus, enacting the provision would reduce net direct
spending by $5 million over the 2026-2036 period.
TABLE 2.--ESTIMATED CHANGES IN DIRECT SPENDING UNDER H.R. 3482
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By fiscal year, millions of dollars--
---------------------------------------------------------------------------------------
2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2026-2031 2026-2036
--------------------------------------------------------------------------------------------------------------------------------------------------------
Administrative Support:
Estimated Budget PAuthority................................. * * * * 1 * * * * * * 1 1
Estimated Outlays........................................... * * * * 1 * * * * * * 1 1
Pensions and Medicaid:
Estimated Budget PAuthority................................. 0 0 0 0 0 0 0 -5 0 0 0 0 -5
Estimated Outlays........................................... 0 0 0 0 0 0 0 -5 0 0 0 0 -5
Total Changes:
Estimated PBudget PAuthority............................ * * * * 1 * * -5 * * * 1 -4
Estimated POutlays...................................... * * * * 1 * * -5 * * * 1 -4
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* = between zero and $500,000.
Spending subject to appropriation: In addition to requiring
VA to provide training, conduct outreach to community
providers, and develop guidelines for the electronic scheduling
system, the bill would require the department to submit reports
to the Congress on the implementation and use of that system.
Based on the costs of similar reporting requirements, CBO
estimates that preparing those reports would cost less than
$500,000.
In total, CBO estimates that implementing H.R. 3482 would
increase spending subject to appropriation by $3 million over
the 2026-2036 period (see Table 1).
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget-reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in direct spending outlays that are
subject to those pay-as-you-go procedures are shown in Table 2.
Increase in long-term net direct spending and deficits: CBO
estimates that enacting H.R. 3482 would not increase net direct
spending by more than $2.5 billion in any of the four
consecutive 10-year periods beginning in 2037.
CBO estimates that enacting H.R. 3482 would not increase
on-budget deficits by more than $5 billion in any of the four
consecutive 10-year periods beginning in 2037.
Mandates: The bill contains no intergovernmental or
private-sector mandates as defined in the Unfunded Mandates
Reform Act.
Estimate prepared by: Federal costs: Noah Callahan (for
veterans' health care); Logan Smith (for pensions and
Medicaid); Mandates: Brandon Lever.
Estimate reviewed by: David Newman, Chief, Defense,
International Affairs, and Veterans' Affairs Cost Estimates
Unit; Kathleen FitzGerald, Chief, Public and Private Mandates
Unit; Christina Hawley Anthony, Deputy Director of Budget
Analysis.
Estimate approved by: Phillip L. Swagel, Director,
Congressional Budget Office.
Federal Mandates Statement
Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by Section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4 is inapplicable to H.R. 3482, as
amended.
Advisory Committee Statement
No advisory committee within the meaning of section 5(b) of
the Federal Advisory Committee Act would be created by H.R.
3482, as amended.
Applicability to Legislative Branch
The Committee finds that H.R. 3482, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodation within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII of the Rules of the
House of Representatives, the Committee finds that no provision
of H.R. 3482, as amended, would establish or reauthorize a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section would establish the title of the bill as the
``Veterans Community Care Scheduling Improvement Act.''
Section 2. Scheduling of appointments under the Veterans
Community Care Program
This section would amend section 3101(d) of the Johnny
Isakson and David P. Roe, M.D. Veterans Health Care and
Benefits Improvement Act of 2020 to require the VA Secretary to
implement an electronic process by which a scheduler at VA may
schedule an appointment for a veteran with a non-VA health care
provider participating in the Veterans Community Care Program
using an IT system. It would specify that the electronic
process must allow VA schedulers to view, search, and sort
appointments by type of care, location, and date. It would also
require that the process includes the ability to send referral
and authorization documents to community providers and perform
any other function that the VA Secretary determines is
necessary.
This section would require that the process includes the
ability to schedule with VA providers and community providers
and that VA shall implement the process through existing
agreements if practicable.
Under this section, VA would be required to submit two
reports to the Committees on Veterans' Affairs of the House of
Representatives and the Senate. First, if the VA Secretary
identifies any function that should be included in the process
but not included in this bill, a briefing of that function
would be required to be provided within 90 days. Second, within
six months of enactment and semiannually thereafter for three
years, the VA Secretary would have to submit reports detailing
the number and types of community care providers participating;
the number and types of appointments using the new process; a
comparison of the average wait time for appointments scheduled
through the electronic process and through non-electronic
methods; the rates at which veterans cancelled appointments
scheduled through the electronic process; and the rates at
which veterans did not appear for appointments scheduled
through the electronic process.
Under this section, VA would be required to implement the
electronic process no later than two years after the enactment
of this bill. This section would also require the VA Secretary
to establish and provide guidance to VA employees on the
electronic process. This guidance would include procedures for
scheduling appointments; a VHA directive to employees to use
the electronic process to the extent practicable; a VHA
directive to employees requiring them to inform veterans of
direct care appointments when using the electronic process to
book appointments for veterans; procedures for engaging with
community care providers in specialized cases; timeliness and
accuracy standards; and escalation protocols for scheduling
delays or failures.
This section would require the establishment of a formal
training program not later than 180 days after enactment and an
evaluation program within 60 days. The evaluation program would
allow the VA Secretary to prescribe performance benchmarks and
outcome-based metrics for the electronic process. However, the
metrics would have to include time between a referral and a
scheduled appointment, patient satisfaction, and the percentage
of appointments scheduled exclusively through the electronic
process.
This section would also require the VA Secretary to conduct
outreach to encourage non-VA providers participating in the
Veterans Community Care Program to participate in the
scheduling program. This outreach would include establishing a
publicly accessible website with information about the program,
participation procedures, and a point of contact.
Additionally, this section would require the VA Secretary
to submit certain information on the electronic process to both
the House and Senate Committees on Veterans' Affairs.
Guidelines would be submitted 30 days after they were
established. A briefing on the outreach strategy would need to
occur 30 days after it was complete. The benchmarks and metrics
developed would need to be submitted to the House and Senate
Committees on Veterans' Affairs within 180 days of enactment.
Finally, this section would require the Secretary to submit
a plan to both the House and Senate Committees on Veterans'
Affairs to expand the electronic process to all VA appointments
within 90 days of enactment. The plan would be required to
include a timeline, estimated costs, and detail any changes to
policies or procedures that would be necessary to implement the
plan.
Section 3. Extension of certain limits on payment of pension
This section would extend the existing limitation on VA
pension payments to institutionalized veterans without
dependents from January 31, 2033, to June 30, 2033.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, and existing law in which no
change is proposed is shown in roman):
JOHNNY ISAKSON AND DAVID P. ROE, M.D. VETERANS HEALTH CARE AND BENEFITS
IMPROVEMENT ACT OF 2020
* * * * * * *
TITLE III--HEALTH CARE
* * * * * * *
Subtitle B--Scheduling and Consult Management
[SEC. 3101. PROCESS AND REQUIREMENTS FOR SCHEDULING APPOINTMENTS FOR
HEALTH CARE FROM DEPARTMENT OF VETERANS AFFAIRS AND
NON-DEPARTMENT HEALTH CARE.
[(a) Process and Requirements.--
[(1) In general.--Not later than 60 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall--
[(A) establish a process and requirements for
scheduling appointments for--
[(i) health care from the Department
of Veterans Affairs; and
[(ii) health care furnished through
the Veterans Community Care Program
under section 1703 of title 38, United
States Code, by a non-Department health
care provider; and
[(B) submit to the Committee on Veterans'
Affairs of the Senate and the Committee on
Veterans' Affairs of the House of
Representatives a description of such process
and requirements.
[(2) Elements of description.--The description of the
process and requirements for scheduling appointments
for health care required to be submitted under
paragraph (1)(B) shall include--
[(A) information on how such process and
requirements take into account the access
standards established under section 1703B of
title 38, United States Code; and
[(B) the maximum number of days allowed to
complete each step of such process.
[(3) Periodic revision.--
[(A) In general.--The Secretary may revise
the process and requirements required under
paragraph (1) as the Secretary considers
necessary.
[(B) Submittal to congress.--Not later than
30 days before revising the process and
requirements under subparagraph (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 description of such revised
process and requirements, including a
description of any modifications to the
certification and training under subsection
(b).
[(b) Certification and Training on Process and
Requirements.--
[(1) Certification.--Not later than one year after
the date of the enactment of this Act, the Secretary
shall require each individual involved in the
scheduling of appointments for health care from the
Department or health care described in subsection
(a)(1)(A)(ii), including schedulers, clinical
coordinators, and supervisors, to certify to the
Secretary that the individual understands the process
and requirements established under subsection (a),
including the maximum number of days allowed to
complete each step of such process.
[(2) New employees.--The Secretary shall require each
employee hired by the Department on or after the date
of the enactment of this Act who is to be involved in
the scheduling of appointments for health care from the
Department or health care described in subsection
(a)(1)(A)(ii)--
[(A) to undergo training on the process and
requirements established under subsection (a)
as part of training for the position for which
the employee has been hired; and
[(B) to make the certification to the
Secretary required under paragraph (1).
[(c) Method to Monitor Compliance.--
[(1) In general.--Not later than 180 days after the
date of the enactment of this Act, the Secretary shall
establish or maintain a method or tool--
[(A) to enable monitoring of the compliance
of the Department with the process and
requirements established under subsection (a),
including compliance with policies of the
Department relating to the maximum number of
days allowed to complete each step of such
process; and
[(B) to ensure that each medical facility of
the Department complies with such process and
requirements.
[(2) Use throughout department.--
[(A) In general.--The Secretary shall require
each medical facility of the Department to use
the method or tool described in paragraph (1).
[(B) Report.--Not later than one year after
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 indicating whether
each medical facility of the Department is
using the method or tool described in paragraph
(1).
[(d) Comptroller General Report.--Not later than two years
after the date of the enactment of this Act, the Comptroller
General of the United States 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
compliance of the Secretary with the requirements of this
section.]
* * * * * * *
----------
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
1703H. Scheduling of appointments.
* * * * * * *
Subchapter I--GENERAL
* * * * * * *
Sec. 1703H. Scheduling of appointments
(a) Process and Requirements.--(1) Not later than 60 days
after the date of the enactment of this Act, the Secretary of
Veterans Affairs shall--
(A) establish a process and requirements for
scheduling appointments for--
(i) health care from the Department of
Veterans Affairs; and
(ii) health care furnished through the
Veterans Community Care Program under section
1703 of this title, by a non-Department health
care provider; and
(B) submit to the Committee on Veterans' Affairs of
the Senate and the Committee on Veterans' Affairs of
the House of Representatives a description of such
process and requirements.
(2) The description of the process and requirements for
scheduling appointments for health care required to be
submitted under paragraph (1)(B) shall include--
(A) information on how such process and requirements
take into account the access standards established
under section 1703B of this title; and
(B) the maximum number of days allowed to complete
each step of such process.
(3)(A) The Secretary may revise the process and requirements
required under paragraph (1) as the Secretary considers
necessary.
(B) Not later than 30 days before revising the process and
requirements under subparagraph (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 description of such revised process and requirements,
including a description of any modifications to the
certification and training under subsection (b).
(b) Certification and Training on Process and Requirements.--
(1) The Secretary shall require each individual involved in the
scheduling of appointments for health care from the Department
or health care described in subsection (a)(1)(A)(ii), including
schedulers, clinical coordinators, and supervisors, to certify
to the Secretary that the individual understands the process
and requirements established under subsection (a), including
the maximum number of days allowed to complete each step of
such process.
(2) The Secretary shall require each employee hired by the
Department on or after the date of the enactment of this Act
who is to be involved in the scheduling of appointments for
health care from the Department or health care described in
subsection (a)(1)(A)(ii)--
(A) to undergo training on the process and
requirements established under subsection (a) as part
of training for the position for which the employee has
been hired; and
(B) to make the certification to the Secretary
required under paragraph (1).
(c) Method to Monitor Compliance.--(1) The Secretary shall
establish or maintain a method or tool--
(A) to enable monitoring of the compliance of the
Department with the process and requirements
established under subsection (a), including compliance
with policies of the Department relating to the maximum
number of days allowed to complete each step of such
process; and
(B) to ensure that each medical facility of the
Department complies with such process and requirements.
(2) The Secretary shall require each medical facility of the
Department to use the method or tool described in paragraph
(1).
(d) Electronic Process.--(1) The Secretary shall implement an
electronic process through which a scheduler of the Department,
using an information technology system, may schedule an
appointment for health care furnished by the Department or
through the Veterans Community Care Program, under section 1703
of this title, by a non-Department health care provider.
(2) The electronic process under this subsection shall allow
a scheduler, with regards to appointments described in--
(A) either clause of subparagraph (A) of subsection
(a)(1), to view, search, and sort such appointments by
type of care, location, and date; and
(B) clause (ii) of such subparagraph--
(i) to schedule such an appointment;
(ii) to provide referral and authorization
documents directly to a non-Department
provider; and
(iii) to perform any other function the
Secretary determines necessary.
(3) The Secretary shall ensure that the electronic process
allows a scheduler to schedule an appointment for health care
furnished by the Secretary through a health care provider of
the Department.
(4) The Secretary shall implement the electronic process
through an existing agreement if practicable.
(5) The Secretary shall submit to the Committees on Veterans'
Affairs of the Senate and House of Representatives the
following regarding the electronic process:
(A) Not later than 90 days after the Secretary makes
a determination under subparagraph (B)(iii) of
paragraph (2), a briefing regarding the functions the
Secretary has determined necessary.
(B) Not later than six months after the date of the
enactment of Veterans Community Care Scheduling
Improvement Act, and semiannually thereafter during the
following three years, a report regarding operation of
the electronic process during both the semiannual
period preceding the date of the report and the
cumulative period since the date of the enactment of
such Act. Such a report shall include the following for
each such period:
(i) The number of non-Department health care
providers that participated in such electronic
process, disaggregated by--
(I) category of hospital care or
medical services provided; and
(II) medical center of the
Department;
(ii) The number of appointments scheduled
pursuant to the electronic process,
disaggregated by--
(I) category of hospital care or
medical services provided;
(II) medical center of the
Department; and
(III) month.
(iii) A comparison of the average wait time
for appointments scheduled through the
electronic process and through non-electronic
methods, disaggregated by medical center of the
Department.
(iv) The rates at which veterans cancelled
appointments scheduled through the electronic
process.
(v) The rates at which veterans did not
appear for appointments scheduled through the
electronic process.
* * * * * * *
PART IV--GENERAL ADMINISTRATIVE PROVISIONS
* * * * * * *
CHAPTER 55--MINORS, INCOMPETENTS, AND OTHER WARDS
* * * * * * *
Sec. 5503. Hospitalized veterans and estates of incompetent
institutionalized veterans
(a)(1)(A) Where any veteran having neither spouse nor child
is being furnished domiciliary care by the Department, no
pension in excess of $90 per month shall be paid to or for the
veteran for any period after the end of the third full calendar
month following the month of admission for such care.
(B) Except as provided in subparagraph (D) of this paragraph,
where any veteran having neither spouse nor child is being
furnished nursing home care by the Department, no pension in
excess of $90 per month shall be paid to or for the veteran for
any period after the end of the third full calendar month
following the month of admission for such care. Any amount in
excess of $90 per month to which the veteran would be entitled
but for the application of the preceding sentence shall be
deposited in a revolving fund at the Department medical
facility which furnished the veteran nursing care, and such
amount shall be available for obligation without fiscal year
limitation to help defray operating expenses of that facility.
(C) No pension in excess of $90 per month shall be paid to or
for a veteran having neither spouse nor child for any period
after the month in which such veteran is readmitted for care
described in subparagraph (A) or (B) of this paragraph and
furnished by the Department if such veteran is readmitted
within six months of a period of care in connection with which
pension was reduced pursuant to subparagraph (A) or (B) of this
paragraph.
(D) In the case of a veteran being furnished nursing home
care by the Department and with respect to whom subparagraph
(B) of this paragraph requires a reduction in pension, such
reduction shall not be made for a period of up to three
additional calendar months after the last day of the third
month referred to in such subparagraph if the Secretary
determines that the primary purpose for the furnishing of such
care during such additional period is for the Department to
provide such veteran with a prescribed program of
rehabilitation services, under chapter 17 of this title,
designed to restore such veteran's ability to function within
such veteran's family and community. If the Secretary
determines that it is necessary, after such period, for the
veteran to continue such program of rehabilitation services in
order to achieve the purposes of such program and that the
primary purpose of furnishing nursing home care to the veteran
continues to be the provision of such program to the veteran,
the reduction in pension required by subparagraph (B) of this
paragraph shall not be made for the number of calendar months
that the Secretary determines is necessary for the veteran to
achieve the purposes of such program.
(2) The provisions of paragraph (1) shall also apply to a
veteran being furnished such care who has a spouse but whose
pension is payable under section 1521(b) of this title. In such
a case, the Secretary may apportion and pay to the spouse, upon
an affirmative showing of hardship, all or any part of the
amounts in excess of the amount payable to the veteran while
being furnished such care which would be payable to the veteran
if pension were payable under section 1521(c) of this title.
(b) Notwithstanding any other provision of this section or
any other provision of law, no reduction shall be made in the
pension of any veteran for any part of the period during which
the veteran is furnished hospital treatment, or institutional
or domiciliary care, for Hansen's disease, by the United States
or any political subdivision thereof.
(c) Where any veteran in receipt of an aid and attendance
allowance described in subsection (r) or (t) of section 1114 of
this title is hospitalized at Government expense, such
allowance shall be discontinued from the first day of the
second calendar month which begins after the date of the
veteran's admission for such hospitalization for so long as
such hospitalization continues. Any discontinuance required by
administrative regulation, during hospitalization of a veteran
by the Department, of increased pension based on need of
regular aid and attendance or additional compensation based on
need of regular aid and attendance as described in subsection
(l) or (m) of section 1114 of this title, shall not be
effective earlier than the first day of the second calendar
month which begins after the date of the veteran's admission
for hospitalization. In case a veteran affected by this
subsection leaves a hospital against medical advice and is
thereafter admitted to hospitalization within six months from
the date of such departure, such allowance, increased pension,
or additional compensation, as the case may be, shall be
discontinued from the date of such readmission for so long as
such hospitalization continues.
(d)(1) For the purposes of this subsection--
(A) the term ``Medicaid plan'' means a State plan for
medical assistance referred to in section 1902(a) of
the Social Security Act (42 U.S.C. 1396a(a)); and
(B) the term ``nursing facility'' means a nursing
facility described in section 1919 of such Act (42
U.S.C. 1396r), other than a facility that is a State
home with respect to which the Secretary makes per diem
payments for nursing home care pursuant to section
1741(a) of this title.
(2) If a veteran having neither spouse nor child is covered
by a Medicaid plan for services furnished such veteran by a
nursing facility, no pension in excess of $90 per month shall
be paid to or for the veteran for any period after the month of
admission to such nursing facility.
(3) Notwithstanding any provision of title XIX of the Social
Security Act, the amount of the payment paid a nursing facility
pursuant to a Medicaid plan for services furnished a veteran
may not be reduced by any amount of pension permitted to be
paid such veteran under paragraph (2) of this subsection.
(4) A veteran is not liable to the United States for any
payment of pension in excess of the amount permitted under this
subsection that is paid to or for the veteran by reason of the
inability or failure of the Secretary to reduce the veteran's
pension under this subsection unless such inability or failure
is the result of a willful concealment by the veteran of
information necessary to make a reduction in pension under this
subsection.
(5)(A) The provisions of this subsection shall apply with
respect to a surviving spouse having no child in the same
manner as they apply to a veteran having neither spouse nor
child.
(B) The provisions of this subsection shall apply with
respect to a child entitled to pension under section 1542 of
this title in the same manner as they apply to a veteran having
neither spouse nor child.
(6) The costs of administering this subsection shall be paid
for from amounts available to the Department of Veterans
Affairs for the payment of compensation and pension.
(7) This subsection expires on [January 31, 2033] June 30,
2033.
* * * * * * *
MINORITY VIEWS
H.R. 3482, as introduced, would require the Secretary of
Veterans Affairs to deploy the External Provider Scheduling
(EPS) program across the Veterans Health Administration
enterprise within a year of enactment. While Democratic Members
support the intent of this requirement, the bill ignored that
the fact that the technology was not the limiting factor in
improving community care scheduling. VA's ability to use the
EPS technology is only effective if VA has significant
participation in the network of providers who have consented to
opening their scheduling grids to VA. The Department has
struggled to recruit a sufficient network of providers at every
VA medical center and appears to be losing providers almost as
quickly as it is recruiting them. Democratic Members are
concerned that having the software in place without a
sufficient network would further exacerbate existing scheduling
issues by requiring schedulers to check EPS only to learn that
the necessary provider type is not participating, rendering the
tool useless and wasting taxpayer money.
To address this gap, Rep. Budzinski offered an Amendment in
the Nature of a Substitute, which was adopted by voice vote,
requiring the Secretary to formulate a plan for how the
Department would recruit and onboard a substantial network of
community care providers and present that plan to Congress. The
amended bill also requires that VA interfaces the solution to
its own scheduling grids so that a VA scheduler would be able
to see not only community care appointments available, but also
VA Direct Care appointments, giving veterans the opportunity to
make an informed decision about how to access their healthcare.
Additionally, H.R. 3482, as amended, requires the Secretary
to establish a plan to utilize the integrated scheduling
solution to streamline the appointment scheduling process,
whereby a veteran need only make or receive a single phone call
to schedule their appointment. VA's current process requires a
scheduler to call the veteran multiple times and to call
multiple providers looking for an available appointment.
Additionally, the Department has separate queues for VA
provided appointments and community care appointments. It is an
incredibly inefficient way to schedule an appointment and can
add days or weeks to the veteran's wait. The Committee has been
seeking an improvement to this process for a long time, this
technology not only allows the department to streamline its
community care scheduling but to also include appointments
available at VA so that veterans are presented with all options
and are afforded an opportunity to make informed decisions
about their care.
Finally, the bill also requires that the Department
establish benchmark metrics for the system to ensure that the
Department is able to measure whether the program is successful
or not. VA has historically done an insufficient job at
measuring the success of new information technology systems and
programs, which creates concern about whether these systems are
in the best interest of veterans or taxpayers.
Committee Democrats support this bill with the changes made
by Representative Budzinski's ANS and look forward to working
with VA to improve veterans' timely access to the healthcare
they are owed.
Mark Takano,
Ranking Member.
[all]