38 U.S.C. § 1706 — Management of health care: other require-

Page 338 TITLE 38—VETERANS’ BENEFITS § 1706 Editorial Notes AMENDMENTS 2022—Subsec. (d). Pub. L. 117–328 substituted ‘‘section 1725(h)’’ for ‘‘section 1725(f)’’. § 1706. Management of health care: other require- ments (a) In managing the provision of hospital care and medical services under section 1710(a) of this title, the Secretary shall, to the extent feasible, design, establish and manage health care pro- grams in such a manner as to promote cost-ef- fective delivery of health care services in the most clinically appropriate setting. (b)(1) In managing the provision of hospital care and medical services under such section, the Secretary shall ensure that the Department (and each geographic service area of the Vet- erans Health Administration) maintains its ca- pacity to provide for the specialized treatment and rehabilitative needs of disabled veterans (in- cluding veterans with spinal cord dysfunction, blindness, amputations, and mental illness) within distinct programs or facilities of the De- partment that are dedicated to the specialized needs of those veterans in a manner that (A) af- fords those veterans reasonable access to care and services for those specialized needs, and (B) ensures that overall capacity of the Department (and each geographic service area of the Vet- erans Health Administration) to provide such services is not reduced below the capacity of the Department, nationwide, to provide those serv- ices, as of October 9, 1996. The Secretary shall carry out this paragraph in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Com- mittee on Care of Severely Chronically Mentally Ill Veterans. (2) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and reha- bilitative needs of disabled veterans (including veterans with spinal cord dysfunction, trau- matic brain injury, blindness, prosthetics and sensory aids, and mental illness) within distinct programs or facilities shall be measured for seri- ously mentally ill veterans as follows (with all such data to be provided by geographic service area and totaled nationally): (A) For mental health intensive community- based care, the number of discrete intensive care teams constituted to provide such inten- sive services to seriously mentally ill veterans and the number of veterans provided such care. (B) For opioid substitution programs, the number of patients treated annually and the amounts expended. (C) For dual-diagnosis patients, the number treated annually and the amounts expended. (D) For substance-use disorder programs— (i) the number of beds (whether hospital, nursing home, or other designated beds) em- ployed and the average bed occupancy of such beds; (ii) the percentage of unique patients ad- mitted directly to outpatient care during the fiscal year who had two or more addi- tional visits to specialized outpatient care within 30 days of their first visit, with a comparison from 1996 until the date of the report; (iii) the percentage of unique inpatients with substance-use disorder diagnoses treat- ed during the fiscal year who had one or more specialized clinic visits within three days of their index discharge, with a com- parison from 1996 until the date of the re- port; (iv) the percentage of unique outpatients seen in a facility or geographic service area during the fiscal year who had one or more specialized clinic visits, with a comparison from 1996 until the date of the report; and (v) the rate of recidivism of patients at each specialized clinic in each geographic service area of the Veterans Health Adminis- tration. (E) For mental health programs, the number and type of staff that are available at each fa- cility to provide specialized mental health treatment, including satellite clinics, out- patient programs, and community-based out- patient clinics, with a comparison from 1996 to the date of the report. (F) The number of such clinics providing mental health care, the number and type of mental health staff at each such clinic, and the type of mental health programs at each such clinic. (G) The total amounts expended for mental health during the fiscal year. (3) For purposes of paragraph (1), the capacity of the Department (and each geographic service area of the Veterans Health Administration) to provide for the specialized treatment and reha- bilitative needs of disabled veterans within dis- tinct programs or facilities shall be measured for veterans with spinal cord dysfunction, trau- matic brain injury, blindness, or prosthetics and sensory aids as follows (with all such data to be provided by geographic service area and totaled nationally): (A) For spinal cord injury and dysfunction specialized centers and for blind rehabilitation specialized centers, the number of staffed beds and the number of full-time equivalent em- ployees assigned to provide care at such cen- ters. (B) For prosthetics and sensory aids, the an- nual amount expended. (C) For traumatic brain injury, the number of patients treated annually and the amounts expended. (4) In carrying out paragraph (1), the Sec- retary may not use patient outcome data as a substitute for, or the equivalent of, compliance with the requirement under that paragraph for maintenance of capacity. (5)(A) Not later than April 1 of each year, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and House of Representatives a report on the Secretary’s compliance, by facility and by service-network, with the requirements of this subsection. Each such report shall include information on recidi- vism rates associated with substance-use dis- order treatment. Page 339 TITLE 38—VETERANS’ BENEFITS § 1706A (B) In preparing each report under subpara- graph (A), the Secretary shall use standardized data and data definitions. (C) Each report under subparagraph (A) shall be audited by the Inspector General of the De- partment, who shall submit to Congress a cer- tification as to the accuracy of each such report. (6)(A) To ensure compliance with paragraph (1), the Under Secretary for Health shall pre- scribe objective standards of job performance for employees in positions described in subpara- graph (B) with respect to the job performance of those employees in carrying out the require- ments of paragraph (1). Those job performance standards shall include measures of workload, allocation of resources, and quality-of-care indi- cators. (B) Positions described in this subparagraph are positions in the Veterans Health Adminis- tration that have responsibility for allocating and managing resources applicable to the re- quirements of paragraph (1). (C) The Under Secretary shall develop the job performance standards under subparagraph (A) in consultation with the Advisory Committee on Prosthetics and Special Disabilities Programs and the Committee on Care of Severely Chron- ically Mentally Ill Veterans. (c) The Secretary shall ensure that each pri- mary care health care facility of the Depart- ment develops and carries out a plan to provide mental health services, either through referral or direct provision of services, to veterans who require such services. (Added Pub. L. 104–262, title I, § 104(a)(1), Oct. 9, 1996, 110 Stat. 3183; amended Pub. L. 105–368, title IX, § 903(a), title X, § 1005(b)(2), Nov. 11, 1998, 112 Stat. 3360, 3365; Pub. L. 107–95, § 8(a), Dec. 21, 2001, 115 Stat. 919; Pub. L. 107–135, title II, § 203, Jan. 23, 2002, 115 Stat. 2458; Pub. L. 109–461, title II, § 208(a), Dec. 22, 2006, 120 Stat. 3413; Pub. L. 114–223, div. A, title II, § 253, Sept. 29, 2016, 130 Stat. 894.) Editorial Notes AMENDMENTS 2016—Subsec. (b)(5)(A). Pub. L. 114–223 struck out ‘‘through 2008’’ after ‘‘each year’’. 2006—Subsec. (b)(5)(A). Pub. L. 109–461 substituted ‘‘2008’’ for ‘‘2004’’. 2002—Subsec. (b)(1). Pub. L. 107–135, § 203(a)(1), in- serted ‘‘(and each geographic service area of the Vet- erans Health Administration)’’ after ‘‘ensure that the Department’’ in introductory provisions and ‘‘(and each geographic service area of the Veterans Health Admin- istration)’’ after ‘‘overall capacity of the Department’’ in cl. (B). Subsec. (b)(2) to (4). Pub. L. 107–135, § 203(a)(3), added pars. (2) to (4). Former pars. (2) and (3) redesignated (5) and (6), respectively. Subsec. (b)(5). Pub. L. 107–135, § 203(a)(2), (b), redesig- nated par. (2) as (5), inserted ‘‘(A)’’ before ‘‘Not later than’’, substituted ‘‘April 1 of each year through 2004’’ for ‘‘April 1, 1999, April 1, 2000, and April 1, 2001’’, in- serted at end of subpar. (A) ‘‘Each such report shall in- clude information on recidivism rates associated with substance-use disorder treatment.’’, and added subpars. (B) and (C). Subsec. (b)(6). Pub. L. 107–135, § 203(a)(2), redesignated par. (3) as (6). 2001—Subsec. (c). Pub. L. 107–95 added subsec. (c). 1998—Subsec. (b)(1). Pub. L. 105–368, § 1005(b)(2), sub- stituted ‘‘October 9, 1996’’ for ‘‘the date of the enact- ment of this section’’. Subsec. (b)(2). Pub. L. 105–368, § 903(a)(1), substituted ‘‘April 1, 1999, April 1, 2000, and April 1, 2001’’ for ‘‘April 1, 1997, April 1, 1998, and April 1, 1999’’. Subsec. (b)(3). Pub. L. 105–368, § 903(a)(2), added par. (3). Statutory Notes and Related Subsidiaries DEADLINE FOR PRESCRIBING STANDARDS Pub. L. 105–368, title IX, § 903(b), Nov. 11, 1998, 112 Stat. 3361, provided that: ‘‘The standards of job per- formance required by paragraph (3) of section 1706(b) of title 38, United States Code, as added by subsection (a), shall be prescribed not later than January 1, 1999.’’ § 1706A. Remediation of medical service lines (a) IN GENERAL.—Not later than 30 days after determining under section 1703(e)(1) of this title that a medical service line of the Department is providing hospital care, medical services, or ex- tended care services that does not comply with the standards for quality established by the Sec- retary, the Secretary shall submit to Congress an assessment of the factors that led the Sec- retary to make such determination and a plan with specific actions, and the time to complete them, to be taken to comply with such stand- ards for quality, including the following: (1) Increasing personnel or temporary per- sonnel assistance, including mobile deploy- ment teams. (2) Special hiring incentives, including the Education Debt Reduction Program under sub- chapter VII of chapter 76 of this title and re- cruitment, relocation, and retention incen- tives. (3) Utilizing direct hiring authority. (4) Providing improved training opportuni- ties for staff. (5) Acquiring improved equipment. (6) Making structural modifications to the facility used by the medical service line. (7) Such other actions as the Secretary con- siders appropriate. (b) RESPONSIBLE PARTIES.—In each assessment submitted under subsection (a) with respect to a medical service line, the Secretary shall iden- tify the individuals at the Central Office of the Veterans Health Administration, the facility used by the medical service line, and the central office of the relevant Veterans Integrated Serv- ice Network who are responsible for overseeing the progress of that medical service line in com- plying with the standards for quality estab- lished by the Secretary. (c) INTERIM REPORTS.—Not later than 180 days after submitting an assessment under sub- section (a) with respect to a medical service line, the Secretary shall submit to Congress a report on the progress of that medical service line in complying with the standards for quality established by the Secretary and any other measures the Secretary will take to assist the medical service line in complying with such standards for quality. (d) ANNUAL REPORTS.—Not less frequently than once each year, the Secretary shall— (1) submit to Congress an analysis of the re- mediation actions and costs of such actions taken with respect to each medical service line with respect to which the Secretary sub-