S.Amdt. 5064

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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