[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4437 Introduced in Senate (IS)]
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118th CONGRESS
2d Session
S. 4437
To require the Secretary of Veterans Affairs to carry out a pilot
program to coordinate, navigate, and manage care and benefits for
veterans enrolled in both the Medicare program and the system of annual
patient enrollment of the Department of Veterans Affairs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 3, 2024
Mr. Moran (for himself and Mr. King) introduced the following bill;
which was read twice and referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To require the Secretary of Veterans Affairs to carry out a pilot
program to coordinate, navigate, and manage care and benefits for
veterans enrolled in both the Medicare program and the system of annual
patient enrollment of the Department of Veterans Affairs.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Coordinating Care for Senior
Veterans and Wounded Warriors Act''.
SEC. 2. PILOT PROGRAM ON COORDINATION OF CARE BETWEEN DEPARTMENT OF
VETERANS AFFAIRS AND MEDICARE PROGRAM.
(a) In General.--The Secretary, in consultation with the Secretary
of Health and Human Services, shall carry out a pilot program (in this
section referred to as the ``pilot program'') to coordinate, navigate,
and manage care and benefits for covered veterans.
(b) Purposes of Pilot Program.--The purposes of the pilot program
are as follows:
(1) To improve access to health care services for covered
veterans at medical facilities of the Department of Veterans
Affairs, from health care providers under the Veterans
Community Care Program under section 1703 of title 38, United
States Code, from health care providers with which the
Department has established a Veterans Care Agreement under
section 1703A of such title, and from health care providers
participating in the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(2) To improve outcomes of care received by covered
veterans.
(3) To improve quality of care received by covered
veterans.
(4) To lower costs of care received by covered veterans.
(5) To eliminate gaps in care and duplication of services
and expenses for covered veterans.
(6) To improve care coordination for covered veterans,
including coordination of patient information and medical
records between providers.
(c) Administration.--
(1) In general.--The Secretary shall carry out the pilot
program through the Center for Innovation for Care and Payment
of the Department of Veterans Affairs.
(2) Locations.--The Secretary shall carry out the pilot
program in not less than three but not more than five Veterans
Integrated Service Networks with a large number of covered
veterans and varying degrees of urbanization, including--
(A) locations that are in rural or highly rural
areas, as determined through the use of the Rural-Urban
Commuting Areas coding system of the Department of
Agriculture; and
(B) locations that are medically underserved.
(d) Case Manager.--
(1) Assignment of case manager.--In carrying out the pilot
program, the Secretary shall assign each covered veteran
participating in the pilot program a case manager responsible
for developing an individualized needs assessment for such
veteran and, based on such assessment, a care coordination plan
with defined treatment goals.
(2) Accessing services.--A case manager assigned to a
covered veteran under paragraph (1) is responsible for
assisting such veteran in accessing services needed by such
veteran and navigating the systems of care under the laws
administered by the Secretary and under the Medicare program
under title XVIII of the Social Security Act (42 U.S.C. 1395 et
seq.).
(e) Use of Existing Models.--In designing the pilot program, the
Secretary shall, to the extent practicable, use existing models,
including value-based care models, used by commercial health care
programs to improve access, health outcomes, quality, and customer
experience and lower per capita costs.
(f) Contracting With Private Sector Entities.--
(1) In general.--The Secretary shall, to the greatest
extent practicable, contract with private sector entities
carrying out commercial health care programs for assistance in
designing, implementing, and managing care and benefits under
the pilot program, to include providing care coordination.
(2) Notification.--If the Secretary determines that
contracting with private sector entities under paragraph (1) is
not practicable, the Secretary shall submit to the Committee on
Veterans' Affairs of the Senate and the Committee on Veterans'
Affairs of the House of Representatives--
(A) a notification of that determination;
(B) a description of the steps the Secretary has
taken to contract with a private sector entity;
(C) a justification for why the Secretary has
determined that contracting with a private sector
entity is not practicable; and
(D) a plan for how the Secretary will carry out the
pilot program without contracting with a private sector
entity, including through the use of employees of the
Department of Veterans Affairs or other government
agencies, nonprofit organizations, or other entities.
(g) Metrics.--
(1) In general.--The Secretary shall track metrics under
the pilot program, including the following:
(A) The number of veterans participating in the
pilot program, disaggregated by Veterans Integrated
Service Network.
(B) Reliance on health care services administered
by the Secretary.
(C) Reliance on health care services administered
under the Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(D) Quality of care, including patient outcomes.
(E) Cost of care.
(F) Access to care, including under the designated
access standards developed by the Secretary under
section 1703B of title 38, United States Code.
(G) Patient satisfaction.
(H) Provider satisfaction.
(I) Care coordination, including timely information
sharing and medical documentation return.
(2) Elements.--In tracking metrics under paragraph (1), the
Secretary shall track information relating to--
(A) whether care received by a covered veteran is
related to a service-connected disability (as defined
in section 101 of title 38, United States Code);
(B) the priority group under section 1705(a) of
title 38, United States Code, through which each
covered veteran was enrolled in the system of annual
patient enrollment of the Department of Veterans
Affairs under such section;
(C) the type of care and services provided to
covered veterans; and
(D) the demographics of covered veterans
participating in the pilot program, including age.
(h) Duration.--The Secretary shall carry out the pilot program for
a 3-year period beginning on the commencement of the pilot program.
(i) Reports.--
(1) Development, implementation, results, and design of
pilot program.--
(A) In general.--Not less frequently than quarterly
during the two-year period beginning on the date of the
enactment of this Act, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and
the Committee on Veterans' Affairs of the House of
Representatives a report on the development,
implementation, results, and design of the pilot
program, including information on the metrics tracked
under subsection (g).
(B) Final design.--One of the reports required
under subparagraph (A) shall contain a description of
the final design of the pilot program.
(2) Results of pilot program.--Not later than one year
after the submission of the final report under paragraph (1),
and not less frequently than annually thereafter during the
duration of the pilot program, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a report on the results of the pilot program.
(3) Final report.--Not later than 180 days before the
termination of the pilot program, the Secretary shall submit to
the Committee on Veterans' Affairs of the Senate and the
Committee on Veterans' Affairs of the House of Representatives
a final report on the pilot program, which shall include the
recommendation of the Secretary for whether the pilot program
should be extended or made permanent.
(j) Definitions.--In this section:
(1) Covered veteran.--The term ``covered veteran'' means a
veteran who is enrolled in both the Medicare program under
title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.)
and the system of annual patient enrollment of the Department
of Veterans Affairs under section 1705(a) of title 38, United
States Code.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Veterans Affairs.
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