Improvements to Department of Veterans Affairs Mental Health Residential Rehabilitation Treatment Program

(a) Performance metrics (1) In general The Secretary of Veterans Affairs shall develop metrics to track, and shall subsequently track, the performance of medical facilities and Veterans Integrated Service Networks of the Department of Veterans Affairs in meeting the requirements for— (A) screening, under section 202, for a covered treatment program; and (B) timely admission to a covered treatment program under such screening. (2) Elements The metrics developed under paragraph (1) shall include metrics for tracking the performance of medical facilities and Veterans Integrated Service Networks with respect to routine and priority admission under a covered treatment program. (b) Oversight (1) In general The Secretary shall develop a process for systematically assessing the quality of care delivered by Department and non-Department providers treating covered veterans under this section, which shall include assessments of— (A) the extent to which the provider is delivering evidence-based treatments to covered veterans; (B) clinical outcomes for covered veterans; (C) the ratio of licensed independent practitioners per resident; (D) the rate of completion of training on military cultural competence by licensed independent practitioners; and (E) potentially wasteful, fraudulent, or inappropriate referral or billing practices. (c) Placement; transportation (1) Locations If the Secretary determines that a covered veteran is in need of residential care under a covered treatment program, the Secretary shall provide to the covered veteran a list of locations at which such covered veteran can receive such residential care that meets— (A) the standards for screening under section 202; and (B) the care needs of the covered veteran, including applicable treatment tracks. (2) Transportation coverage The Secretary shall provide transportation or pay for or reimburse the costs of transportation for any covered veteran who is admitted into a covered treatment program and needs transportation assistance— (A) from the residence of the covered veteran or a facility of the Department or authorized non-Department facility that does not provide such care to another such facility that provides residential care covered under a covered treatment program; and (B) back to the residence of the covered veteran after the conclusion of a covered treatment program, if applicable. (d) Appeals (1) In general The Secretary shall develop a national policy and associated procedures under which a covered veteran, a representative of a covered veteran, or a provider who requests a covered veteran be admitted to a covered treatment program, including a provider of the Department or a non-Department provider, may file a clinical appeal pursuant to this subsection if the covered veteran is— (A) denied admission into a covered treatment program; or (B) accepted into a covered treatment program but is not offered bed placement in a timely manner. (2) Timeliness standards for review (A) In general The national policy and procedures developed under paragraph (1) for appeals described in such paragraph shall include timeliness standards for the Department to review and make a decision on such an appeal. (B) Decision The Secretary shall review and respond to any appeal under paragraph (1) not later than 72 hours after the Secretary receives such appeal. (3) Public guidance The Secretary shall develop, and make available to the public, guidance on how a covered veteran, a representative of the covered veteran, or a provider of the covered veteran can file a clinical appeal pursuant to this subsection— (A) if the covered veteran is denied admission into a covered treatment program; (B) if the first date on which the covered veteran may enter a covered treatment program does not comply with the standards established by the Department under section 1703B of title 38, United States Code, for purposes of determining eligibility for mental health care under subsections (d) and (e) of section 1703 of such title; or (C) with respect to such other factors as the Secretary may specify. (4) Rule of construction Nothing in this subsection may be construed as granting a covered veteran the right to appeal a decision of the Secretary with respect to admission to a covered treatment program to the Board of Veterans’ Appeals under chapter 71 of title 38, United States Code. (e) Tracking of availability and wait times (1) In general The Secretary shall, to the extent practicable, create a method for tracking availability and wait times under a covered treatment program across all facilities of the Department, Veterans Integrated Service Networks of the Department, and non-Department providers throughout the United States. (2) Availability of information The Secretary shall, to the extent practicable, make the information tracked under paragraph (1) available in real time to— (A) the mental health treatment coordinators at each facility of the Department; (B) the leadership of each medical center of the Department; (C) the leadership of each Veterans Integrated Service Network; and (D) the Office of the Under Secretary for Health of the Department. (f) Training and oversight (1) Training (A) In general The Secretary shall update and implement training for staff of the Department directly involved in a covered treatment program regarding referrals, screening, admission, placement decisions, and appeals for such program, including all changes to processes and guidance under such program required by this section and section 202. (B) Covered veterans awaiting admission The training under subparagraph (A) shall include procedures for the care of covered veterans awaiting admission into a covered treatment program and communication with such covered veterans and the providers of such covered veterans. (C) Timing of training (i) In general The Secretary shall require the training under subparagraph (A) to be completed by staff required to complete such training— (I) not later than 60 days after beginning employment at the Department in a position that includes work directly involving a covered treatment program; and (II) not less frequently than annually. (ii) Tracking The Secretary shall track completion of training required under clause (i) by staff required to complete such training. (2) Oversight standards The Secretary shall review and revise oversight standards for the leadership of the Veterans Integrated Service Networks and the Veterans Health Administration to ensure that facilities and staff of the Department are adhering to the policy on access to care of each covered treatment program. (g) Care coordination and follow-Up care (1) Continuity of care The Secretary shall ensure each covered veteran who is screened for admission to a covered treatment program is offered, and provided if agreed upon, care options during the period between screening of the covered veteran and admission of the covered veteran to such program to ensure the covered veteran does not experience any lapse in care. (2) Care coordination for substance use disorder For a covered veteran being treated for substance use disorder, the Secretary shall— (A) ensure there is a care plan in place during the period between any detoxification services or inpatient care received by the covered veteran and admission of the covered veteran to a covered treatment program; and (B) communicate that care plan to the covered veteran, the primary care provider of the covered veteran, and the facility where the covered veteran is or will be residing under such program. (3) Care planning prior to discharge (A) In general The Secretary, in consultation with the covered veteran and the treating providers of the covered veteran in a covered treatment program, shall ensure the completion of a care plan prior to the covered veteran being discharged from such program. (B) Matters to be included The care plan required under subparagraph (A) for a covered veteran shall include details on the course of treatment for the covered veteran following completion of treatment under the covered treatment program, including any necessary follow-up care. (C) Sharing of care plan The care plan required under subparagraph (A) shall be shared with the covered veteran, the primary care provider of the covered veteran, and any other providers with which the covered veteran consents to sharing the plan. (D) Discharge from non-department facility Upon discharge of a covered veteran under a covered treatment program from a non-Department facility, the facility shall share with the Department all care records maintained by the facility with respect to the covered veteran and shall work in consultation with the Department on the care plan of the covered veteran required under subparagraph (A). (h) Reports to Congress (1) Report on modifications to programs (A) In general Not later than two years 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 on modifications made to the guidance, operation, and oversight of covered treatment programs to fulfill the requirements of this section. (B) Elements The report required by subparagraph (A) shall include— (i) an assessment of whether costs of covered treatment programs, including for residential care provided through facilities of the Department and non-Department facilities, serve as a disincentive to placement in the such a program; (ii) a description of actions taken by the Department to address the findings and recommendations by the Secretary contained in the report under section 503(c) of the STRONG Veterans Act of 2022 (division V of Public Law 117–328; 136 Stat. 5515), including— (I) such actions with respect to— (aa) any new locations added for covered treatment programs; (bb) any beds added at existing facilities of such programs; and (cc) any additional treatment tracks or sex-specific programs created or added at facilities of the Department; and (II) a breakdown of the number and percentage of covered veterans who are determined eligible for priority placement into a covered treatment program and the number and percentage of covered veterans who are determined eligible for routine placement into a covered treatment program; and (iii) such recommendations as the Secretary may have for legislative or administrative action to address any funding constraints or disincentives for use of a covered treatment program. (2) Annual report on operation of programs (A) In general Not later than one year after the submission of the report under paragraph (1), and not less frequently than annually thereafter during the period in which a covered treatment program is carried out, 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 operation of such programs. (B) Elements Subject to subparagraph (C), each report required by subparagraph (A) shall include the following: (i) The number of covered veterans served by a covered treatment program, disaggregated by— (I) Veterans Integrated Service Network in which the covered veteran receives care; (II) facility, including facilities of the Department and non-Department facilities, at which the covered veteran receives care; (III) type of residential rehabilitation treatment care received by the covered veteran under such program; (IV) sex of the covered veteran; and (V) race or ethnicity of the covered veteran. (ii) Wait times under a covered treatment program for the most recent year data is available, disaggregated by— (I) treatment track or specificity of residential rehabilitation treatment care sought by the covered veteran; (II) sex of the covered veteran; (III) State or territory in which the covered veteran is located; (IV) Veterans Integrated Service Network in which the covered veteran is located; and (V) facility of the Department at which the covered veteran seeks care. (iii) A list of all locations of a covered treatment program and number of bed spaces at each such location, disaggregated by residential rehabilitation treatment care or treatment track provided under such program at such location. (iv) A list of any new locations of covered treatment programs added or removed and any bed spaces added or removed during the one-year period preceding the date of the report. (v) Average cost of a stay under a covered treatment program, including total stay average and daily average, at facilities of the Department compared to non-Department facilities. (vi) A review of staffing needs and gaps with respect to covered treatment programs. (vii) Any recommendations for changes to the operation of covered treatment programs, including any policy changes, guidance changes, training changes, or other changes. (C) Anonymity To ensure that the data provided under this paragraph, or some portion of that data, will not undermine the anonymity of a veteran, the Secretary shall provide such data pursuant to applicable Federal law and in a manner that is wholly consistent with applicable Federal privacy and confidentiality laws, including— (i) section 552a of title 5, United States Code (commonly known as the Privacy Act of 1974); (ii) the Health Insurance Portability and Accountability Act of 1996 (Public Law 104–191); (iii) parts 160 and 164 of title 45, Code of Federal Regulations, or successor regulations; and (iv) sections 5701, 5705, and 7332 of title 38, United States Code. (i) Revision of guidance The Secretary shall update the guidance of the Department on the operation of covered treatment programs to reflect each of the requirements under subsections (b) through (h). (j) Deadline The Secretary shall carry out each requirement under this section by not later than one year after the date of the enactment of this Act, unless otherwise specified. (k) Comptroller General review (1) In general Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall review access to care under a covered treatment program for covered veterans in need of residential mental health care and substance use disorder care. (2) Elements The review required by paragraph (1) shall include the following: (A) A review of wait times under a covered treatment program, disaggregated by— (i) treatment track or specificity of residential rehabilitation treatment care needed; (ii) sex of the covered veteran; (iii) home State of the covered veteran; (iv) home Veterans Integrated Service Network of the covered veteran; and (v) wait times for— (I) facilities of the Department; and (II) non-Department facilities. (B) A review of policy and training of the Department on screening, admission, and placement under a covered treatment program. (C) A review of the rights of covered veterans and providers to appeal admission decisions under a covered treatment program and how the Department adjudicates appeals. (D) When determining the facility at which a covered veteran admitted to a covered treatment program will be placed in such program, a review of how the input of the covered veteran is taken into consideration with respect to— (i) program specialty, subtype, or treatment track offered to the covered veteran; and (ii) the geographic placement of the covered veteran, including family- or occupation-related preferences or circumstances. (E) A review of staffing and staffing needs and gaps of covered treatment programs, including with respect to— (i) mental health providers and coordinators at the facility level; (ii) staff of facilities of such programs; (iii) staff of Veterans Integrated Service Networks; and (iv) overall administration of such programs at the national level. (F) Recommendations for improvement of access by covered veterans to care under a covered treatment program, including with respect to— (i) any new sites or types of programs needed or in development; (ii) changes in training or policy; (iii) changes in communications with covered veterans; and (iv) oversight of covered treatment programs by the Department.