38 U.S.C. § 1703 — Veterans Community Care Program

Page 309 TITLE 38—VETERANS’ BENEFITS § 1703 CONTRACT HEALTH CARE; RATIFICATION OF ACTION OF ADMINISTRATOR OF VETERANS’ AFFAIRS Pub. L. 98–528, title I, § 103(b), Oct. 19, 1984, 98 Stat. 2688, ratified actions by Administrator of Veterans’ Af- fairs in entering into contracts applicable to the period beginning Oct. 1, 1984, and ending Oct. 19, 1984, for care described in par. (4)(C)(v) of this section and in making waivers described in that provision. ADMINISTRATION CAPABILITY TO PROVIDE APPROPRIATE CARE FOR GENDER-SPECIFIC DISABILITIES OF WOMEN VETERANS Pub. L. 98–160, title III, § 302, Nov. 21, 1983, 97 Stat. 1004, as amended by Pub. L. 102–40, title IV, § 402(d)(2), May 7, 1991, 105 Stat. 239; Pub. L. 102–83, §§ 5(c)(2), 6(f), Aug. 6, 1991, 105 Stat. 406, 407, provided that: ‘‘The Sec- retary of Veterans Affairs shall ensure that each health-care facility under the direct jurisdiction of the Secretary is able, through services made available ei- ther by individuals appointed to positions in the Vet- erans Health Administration or under contracts or other agreements made under section 4117 [see 7409], 8111, or 8153 of title 38, United States Code, to provide appropriate care, in a timely fashion, for any gender- specific disability (as defined in section 1701(1) of such title) of a woman veteran eligible for such care under chapter 17 or chapter 31 of such title.’’ ANNUAL REPORT TO CONGRESS COVERING CONTRACT- CARE PROGRAMS Pub. L. 96–22, title II, § 201(b), June 13, 1979, 93 Stat. 54, which directed Chief Medical Director of the Vet- erans’ Administration to report to appropriate commit- tees of Congress, not later than Feb. 1, 1980, and annu- ally thereafter, on implementation of former par. (4)(C)(v) of this section and amendments made to this section by section 201 of Pub. L. 96–22, and on numbers of veterans provided contract treatment (and average cost and duration thereof) in each State in certain enu- merated categories, was repealed by Pub. L. 100–322, title I, § 112(b), May 20, 1988, 102 Stat. 499. HOSPITAL CARE AND MEDICAL SERVICES FURNISHED BY VETERANS’ ADMINISTRATION IN PUERTO RICO AND VIRGIN ISLANDS; REPORT TO PRESIDENT AND CON- GRESS Pub. L. 95–520, § 8, Oct. 26, 1978, 92 Stat. 1822, as amended by Pub. L. 96–330, title IV, § 407, Aug. 26, 1980, 94 Stat. 1053, directed Administrator of Veterans’ Af- fairs, not later than Feb. 1, 1981, to submit a report to President and Congress on furnishing by Administra- tion of hospital care and medical services in Puerto Rico and Virgin Islands, and set forth applicable cri- teria and considerations for the report. § 1702. Presumptions: psychosis after service in World War II and following periods of war; mental illness after service in the Persian Gulf War (a) PSYCHOSIS.—For the purposes of this chap- ter, any veteran of World War II, the Korean conflict, the Vietnam era, or the Persian Gulf War who developed an active psychosis (1) with- in two years after discharge or release from the active military, naval, or air service, and (2) be- fore July 26, 1949, in the case of a veteran of World War II, before February 1, 1957, in the case of a veteran of the Korean conflict, before May 8, 1977, in the case of a Vietnam era veteran, or before the end of the two-year period beginning on the last day of the Persian Gulf War, in the case of a veteran of the Persian Gulf War, shall be deemed to have incurred such disability in the active military, naval, or air service. (b) MENTAL ILLNESS.—For purposes of this chapter, any veteran of the Persian Gulf War who develops an active mental illness (other than psychosis) shall be deemed to have in- curred such disability in the active military, naval, or air service if such veteran develops such disability— (1) within two years after discharge or re- lease from the active military, naval, or air service; and (2) before the end of the two-year period be- ginning on the last day of the Persian Gulf War. (Pub. L. 85–857, Sept. 2, 1958, 72 Stat. 1141, § 602; Pub. L. 90–77, title II, § 203(a), Aug. 31, 1967, 81 Stat. 183; Pub. L. 97–295, § 4(16), Oct. 12, 1982, 96 Stat. 1306; Pub. L. 99–576, title VII, § 701(20), Oct. 28, 1986, 100 Stat. 3292; Pub. L. 102–25, title III, § 334(b), Apr. 6, 1991, 105 Stat. 88; renumbered § 1702, Pub. L. 102–83, § 5(a), Aug. 6, 1991, 105 Stat. 406; Pub. L. 110–181, div. A, title XVII, § 1708(a)(1), (2), Jan. 28, 2008, 122 Stat. 493, 494.) Editorial Notes AMENDMENTS 2008—Pub. L. 110–181, § 1708(a)(2), substituted ‘‘Pre- sumptions: psychosis after service in World War II and following periods of war; mental illness after service in the Persian Gulf War’’ for ‘‘Presumption relating to psychosis’’ in section catchline. Subsecs. (a), (b). Pub. L. 110–181, § 1708(a)(1), des- ignated existing text as subsec. (a), inserted heading, and added subsec. (b). 1991—Pub. L. 102–83 renumbered section 602 of this title as this section. Pub. L. 102–25 substituted ‘‘the Vietnam era, or the Persian Gulf War’’ for ‘‘or the Vietnam era’’, struck out ‘‘or’’ before ‘‘before May 8, 1977’’, and inserted ‘‘or be- fore the end of the two-year period beginning on the last day of the Persian Gulf War, in the case of a vet- eran of the Persian Gulf War,’’ after ‘‘Vietnam era vet- erans,’’. 1986—Pub. L. 99–576 struck out ‘‘his’’ before ‘‘dis- charge’’. 1982—Pub. L. 97–295 substituted ‘‘before February 1, 1957, in the case of a veteran of the Korean conflict, or before May 8, 1977,’’ for ‘‘or February 1, 1957, in the case of a veteran of the Korean conflict, or before the expi- ration of two years following termination of the Viet- nam era’’. 1967—Pub. L. 90–77 made the presumption relating to psychosis applicable to any veteran of the Vietnam era who developed an active psychosis within two years after his discharge from active service and before the expiration of two years following termination of the Vietnam era. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 1967 AMENDMENT Amendment by Pub. L. 90–77 effective first day of first calendar month which begins more than ten days after Aug. 31, 1967, see section 405 of Pub. L. 90–77, set out as a note under section 101 of this title. § 1703. Veterans Community Care Program (a) IN GENERAL.—(1) There is established a pro- gram to furnish hospital care, medical services, and extended care services to covered veterans through health care providers specified in sub- section (c). (2) The Secretary shall coordinate the fur- nishing of hospital care, medical services, and extended care services under this section to cov- ered veterans, including coordination of, at a minimum, the following: Page 310 TITLE 38—VETERANS’ BENEFITS § 1703 (A) Ensuring the scheduling of medical ap- pointments in a timely manner and the estab- lishment of a mechanism to receive medical records from non-Department providers. (B) Ensuring continuity of care and services. (C) Ensuring coordination among regional networks if the covered veteran accesses care and services in a different network than the regional network in which the covered veteran resides. (D) Ensuring that covered veterans do not experience a lapse in care resulting from er- rors or delays by the Department or its con- tractors or an unusual or excessive burden in accessing hospital care, medical services, or extended care services. (3) A covered veteran may only receive care or services under this section upon the authoriza- tion of such care or services by the Secretary. (4) Nothing in this section shall be construed to authorize the Secretary to suspend the pro- gram established under paragraph (1). (b) COVERED VETERANS.—For purposes of this section, a covered veteran is any veteran who— (1) is enrolled in the system of annual pa- tient enrollment established and operated under section 1705 of this title; or (2) is not enrolled in such system but is oth- erwise entitled to hospital care, medical serv- ices, or extended care services under sub- section (c)(2) of such section. (c) HEALTH CARE PROVIDERS SPECIFIED.— Health care providers specified in this sub- section are the following: (1) Any health care provider that is partici- pating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including any physician furnishing services under such a program. (2) The Department of Defense. (3) The Indian Health Service. (4) Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Se- curity Act (42 U.S.C. 1396d(l)(2)(B))). (5) Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Sec- retary for purposes of this section. (d) CONDITIONS UNDER WHICH CARE IS REQUIRED TO BE FURNISHED THROUGH NON-DEPARTMENT PROVIDERS.—(1) The Secretary shall, subject to the availability of appropriations, furnish hos- pital care, medical services, and extended care services to a covered veteran through health care providers specified in subsection (c) if— (A) the Department does not offer the care or services the veteran requires; (B) the Department does not operate a full- service medical facility in the State in which the covered veteran resides; (C)(i) the covered veteran was an eligible veteran under section 101(b)(2)(B) of the Vet- erans Access, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) as of the day before the date of the enactment of the Caring for Our Veterans Act of 2018; (ii) continues to reside in a location that would qualify the veteran for eligibility under such section; and (iii) either— (I) resides in one of the five States with the lowest population density as determined by data from the 2010 decennial census; or (II) resides in a State not described in sub- clause (I) and— (aa) received care or services under this title in the year preceding the enactment of the Caring for Our Veterans Act of 2018; and (bb) is seeking care or services within 2 years of the date of the enactment of the Caring for Our Veterans Act of 2018; (D) the covered veteran has contacted the Department to request care or services and the Department is not able to furnish such care or services in a manner that complies with designated access standards developed by the Secretary under section 1703B of this title; or (E) the covered veteran and the covered vet- eran’s referring clinician agree that furnishing care and services through a non-Department entity or provider would be in the best med- ical interest of the covered veteran based upon criteria developed by the Secretary. (2) The Secretary shall ensure that the cri- teria developed under paragraph (1)(E) include consideration of the following: (A) The distance between the covered vet- eran and the facility that provides the hos- pital care, medical services, or extended care services the veteran needs. (B) The nature of the hospital care, medical services, or extended care services required. (C) The frequency that the hospital care, medical services, or extended care services needs to be furnished. (D) The timeliness of available appointments for the hospital care, medical services, or ex- tended care services the veteran needs. (E) Whether the covered veteran faces an un- usual or excessive burden to access hospital care, medical services, or extended care serv- ices from the Department medical facility where a covered veteran seeks hospital care, medical services, or extended care services, which shall include consideration of the fol- lowing: (i) Whether the covered veteran faces an excessive driving distance, geographical challenge, or environmental factor that im- pedes the access of the covered veteran. (ii) Whether the hospital care, medical services, or extended care services sought by the veteran is provided by a medical facility of the Department that is reasonably acces- sible to a covered veteran. (iii) Whether a medical condition of the covered veteran affects the ability of the covered veteran to travel. (iv) Whether there is compelling reason, as determined by the Secretary, that the vet- eran needs to receive hospital care, medical services, or extended care services from a medical facility other than a medical facil- ity of the Department. (v) Such other considerations as the Sec- retary considers appropriate. (3) If the Secretary has determined that the Department does not offer the care or services Page 311 TITLE 38—VETERANS’ BENEFITS § 1703 the covered veteran requires under subpara- graph (A) of paragraph (1), that the Department does not operate a full-service medical facility in the State in which the covered veteran re- sides under subparagraph (B) of such paragraph, that the covered veteran is described under sub- paragraph (C) of such paragraph, or that the De- partment is not able to furnish care or services in a manner that complies with designated ac- cess standards developed by the Secretary under section 1703B of this title under subparagraph (D) of such paragraph, the decision to receive hospital care, medical services, or extended care services under such subparagraphs from a health care provider specified in subsection (c) shall be at the election of the veteran. (4) In determining under paragraph (1)(D) whether the Department is able to furnish care or services in a manner that complies with des- ignated access standards developed by the Sec- retary under section 1703B of this title, for pur- poses of calculating a wait time for a veteran to schedule an appointment at a medical facility of the Department, 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 pro- vider of the Department, to the first next avail- able appointment date relevant to the requested medical service. (e) CONDITIONS UNDER WHICH CARE IS AUTHOR- IZED TO BE FURNISHED THROUGH NON-DEPART- MENT PROVIDERS.—(1)(A) The Secretary may fur- nish hospital care, medical services, or extended care services through a health care provider specified in subsection (c) to a covered veteran served by a medical service line of the Depart- ment that the Secretary has determined is not providing care that complies with the standards for quality the Secretary shall establish under section 1703C. (B) In carrying out subparagraph (A), the Sec- retary shall— (i) measure timeliness of the medical service line at a facility of the Department when com- pared with the same medical service line at different Department facilities; and (ii) measure quality at a medical service line of a facility of the Department by comparing it with two or more distinct and appropriate quality measures at non-Department medical service lines. (C)(i) The Secretary may not concurrently fur- nish hospital care, medical services, or extended care services under subparagraph (A) with re- spect to more than three medical service lines described in such subparagraph at any one health care facility of the Department. (ii) The Secretary may not concurrently fur- nish hospital care, medical services, or extended care services under subparagraph (A) with re- spect to more than 36 medical service lines na- tionally described in such subparagraph. (2) The Secretary may limit the types of hos- pital care, medical services, or extended care services covered veterans may receive under paragraph (1) in terms of the length of time such care and services will be available, the location at which such care and services will be avail- able, and the clinical care and services that will be available. (3)(A) Except as provided for in subparagraph (B), the hospital care, medical services, and ex- tended care services authorized under paragraph (1) with respect to a medical service line shall cease when the remediation described in section 1706A with respect to such medical service line is complete. (B) The Secretary shall ensure continuity and coordination of care for any veteran who elects to receive care or services under paragraph (1) from a health care provider specified in sub- section (c) through the completion of an episode of care. (4) The Secretary shall publish in the Federal Register, and shall take all reasonable steps to provide direct notice to covered veterans af- fected under this subsection, at least once each year stating the time period during which such care and services will be available, the location or locations where such care and services will be available, and the clinical services available at each location under this subsection in accord- ance with regulations the Secretary shall pre- scribe. (5) When the Secretary exercises the authority under paragraph (1), the decision to receive care or services under such paragraph from a health care provider specified in subsection (c) shall be at the election of the covered veteran. (f) REVIEW OF DECISIONS.—The review of any decision under subsection (d) or (e) shall be sub- ject to the Department’s clinical appeals proc- ess, and such decisions may not be appealed to the Board of Veterans’ Appeals. (g) TIERED NETWORK.—(1) To promote the pro- vision of high-quality and high-value hospital care, medical services, and extended care serv- ices under this section, the Secretary may de- velop a tiered provider network of eligible pro- viders based on criteria established by the Sec- retary for purposes of this section. (2) In developing a tiered provider network of eligible providers under paragraph (1), the Sec- retary shall not prioritize providers in a tier over providers in any other tier in a manner that limits the choice of a covered veteran in se- lecting a health care provider specified in sub- section (c) for receipt of hospital care, medical services, or extended care services under this section. (h) CONTRACTS TO ESTABLISH NETWORKS OF HEALTH CARE PROVIDERS.—(1)(A) The Secretary shall enter into consolidated, competitively bid contracts to establish networks of health care providers specified in paragraphs (1) and (5) of subsection (c) for purposes of providing suffi- cient access to hospital care, medical services, or extended care services under this section. (B) For purposes of subparagraph (A), the re- quirement to enter into consolidated, competi- tively bid contracts shall not restrict the au- thority of the Secretary under other provisions of law when modifying such a contract after en- tering into the contract. (2)(A) The Secretary shall, to the extent prac- ticable, ensure that covered veterans are able to make their own appointments using advanced technology. (B) To the extent practicable, the Secretary shall be responsible for the scheduling of ap- pointments for hospital care, medical services, and extended care services under this section. Page 312 TITLE 38—VETERANS’ BENEFITS § 1703 (3)(A) The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section, if the Secretary notifies the appropriate committees of Congress that, at a minimum— (i) the entity— (I) failed to comply substantially with the provisions of the contract or with the provi- sions of this section and the regulations pre- scribed under this section; (II) failed to comply with the access stand- ards or the standards for quality established by the Secretary; (III) is excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); (IV) is identified as an excluded source on the list maintained in the System for Award Management, or any successor system; or (V) has been convicted of a felony or other serious offense under Federal or State law and the continued participation of the enti- ty would be detrimental to the best interests of veterans or the Department; (ii) it is reasonable to terminate the con- tract based on the health care needs of vet- erans; or (iii) it is reasonable to terminate the con- tract based on coverage provided by contracts or sharing agreements entered into under au- thorities other than this section. (B) Nothing in subparagraph (A) may be con- strued to restrict the authority of the Secretary to terminate a contract entered into under para- graph (1) under any other provision of law. (4) Whenever the Secretary provides notice to an entity that the entity is failing to meet con- tractual obligations entered into under para- graph (1), 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 such fail- ure. Such report shall include the following: (A) An explanation of the reasons for pro- viding such notice. (B) A description of the effect of such fail- ure, including with respect to cost, schedule, and requirements. (C) A description of the actions taken by the Secretary to mitigate such failure. (D) A description of the actions taken by the contractor to address such failure. (E) A description of any effect on the com- munity provider market for veterans in the af- fected area. (5)(A) The Secretary shall instruct each entity awarded a contract under paragraph (1) to recog- nize and accept, on an interim basis, the creden- tials and qualifications of health care providers who are authorized to furnish hospital care and medical services to veterans under a community care program of the Department in effect as of the day before the effective date specified in sec- tion 101(b) of the Caring for Our Veterans Act of 2018, including under the Patient-Centered Com- munity Care Program and the Veterans Choice Program under section 101 of the Veterans Ac- cess, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note), as qualified providers under the program estab- lished under this section. (B) The interim acceptance period under sub- paragraph (A) shall be determined by the Sec- retary based on the following criteria: (i) With respect to a health care provider, when the current certification agreement for the health care provider expires. (ii) Whether the Department has enacted certification and eligibility criteria and regu- latory procedures by which non-Department providers will be authorized under this sec- tion. (6) The Secretary shall establish a system or systems for monitoring the quality of care pro- vided to covered veterans through a network under this subsection and for assessing the qual- ity of hospital care, medical services, and ex- tended care services furnished through such net- work before the renewal of the contract for such network. (i) PAYMENT RATES FOR CARE AND SERVICES.— (1) Except as provided in paragraph (2), and to the extent practicable, the rate paid for hospital care, medical services, or extended care services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier (as defined in section 1861(d) of such Act (42 U.S.C. 1395x(d))) under the Medicare program under title XI or title XVIII of the Social Secu- rity Act (42 U.S.C. 1301 et seq.), including section 1834 of such Act (42 U.S.C. 1395m), for the same care or services. (2)(A) A higher rate than the rate paid by the United States as described in paragraph (1) may be negotiated with respect to the furnishing of care or services to a covered veteran who resides in a highly rural area. (B) In this paragraph, the term ‘‘highly rural area’’ means an area located in a county that has fewer than seven individuals residing in that county per square mile. (3) With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another pay- ment agreement, including a contract or pro- vider agreement, is in effect. (4) With respect to furnishing hospital care, medical services, or extended care services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, the Medicare payment rates under paragraph (2)(A) shall be calculated based on the payment rates under such agreement. (5) Notwithstanding paragraph (1), the Sec- retary may incorporate, to the extent prac- ticable, the use of value-based reimbursement models to promote the provision of high-quality care. (6) With respect to hospital care, medical serv- ices, or extended care services for which there is not a rate paid under the Medicare program as described in paragraph (1), the rate paid for such Page 313 TITLE 38—VETERANS’ BENEFITS § 1703 1 See References in Text note below. care or services shall be determined by the Sec- retary. (j) TREATMENT OF OTHER HEALTH PLAN CON- TRACTS.—In any case in which a covered veteran is furnished hospital care, medical services, or extended care services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of this title, the Secretary shall recover or collect reasonable charges for such care or services from a health plan contract described in section 1729 in accord- ance with such section. (k) PAYMENT BY VETERAN.—A covered veteran shall not pay a greater amount for receiving care or services under this section than the amount the veteran would pay for receiving the same or comparable care or services at a med- ical facility of the Department or from a health care provider of the Department. (l) TRANSPLANT AUTHORITY FOR IMPROVED AC- CESS.—(1) In the case of a covered veteran de- scribed in paragraph (2), the Secretary shall de- termine whether to authorize an organ or bone marrow transplant for that covered veteran at a non-Department facility. (2) A covered veteran described in this para- graph— (A) requires an organ or bone marrow trans- plant; and (B) has, in the opinion of the primary care provider of the veteran, a medically compel- ling reason to travel outside the region of the Organ Procurement and Transplantation Net- work, established under section 372 of the Na- tional Organ Transplantation Act 1 (Public Law 98–507; 42 U.S.C. 274), in which the veteran resides, to receive such transplant. (m) MONITORING OF CARE PROVIDED.—(1)(A) Not later than 540 days after the date of the en- actment of the Caring for Our Veterans Act of 2018, and not less frequently than annually thereafter, the Secretary shall submit to appro- priate committees of Congress a review of the types and frequency of care sought under sub- section (d). (B) The review submitted under subparagraph (A) shall include an assessment of the following: (i) The top 25 percent of types of care and services most frequently provided under sub- section (d) due to the Department not offering such care and services. (ii) The frequency such care and services were sought by covered veterans under this section. (iii) An analysis of the reasons the Depart- ment was unable to provide such care and services. (iv) Any steps the Department took to pro- vide such care and services at a medical facil- ity of the Department. (v) The cost of such care and services. (2) In monitoring the hospital care, medical services, and extended care services furnished under this section, the Secretary shall do the following: (A) With respect to hospital care, medical services, and extended care services furnished through provider networks established under subsection (i)— (i) compile data on the types of hospital care, medical services, and extended care services furnished through such networks and how many patients used each type of care and service; (ii) identify gaps in hospital care, medical services, or extended care services furnished through such networks; (iii) identify how such gaps may be fixed through new contracts within such networks or changes in the manner in which hospital care, medical services, or extended care serv- ices are furnished through such networks; (iv) assess the total amounts spent by the Department on hospital care, medical serv- ices, and extended care services furnished through such networks; (v) assess the timeliness of the Depart- ment in referring hospital care, medical services, and extended care services to such networks; and (vi) assess the timeliness of such networks in— (I) accepting referrals; and (II) scheduling and completing appoint- ments. (B) Report the number of medical service lines the Secretary has determined under sub- section (e)(1) not to be providing hospital care, medical services, or extended care services that comply with the standards for quality es- tablished by the Secretary. (C) Assess the use of academic affiliates and centers of excellence of the Department to fur- nish hospital care, medical services, and ex- tended care services to covered veterans under this section. (D) Assess the hospital care, medical serv- ices, and extended care services furnished to covered veterans under this section by medical facilities operated by Federal agencies other than the Department. (3) Not later than 540 days after the date of the enactment of the Caring for Our Veterans Act of 2018 and not less frequently than once each year thereafter, 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 infor- mation gathered under paragraph (2). (n) PROHIBITION ON CERTAIN LIMITATIONS.—(1) The Secretary shall not limit the types of hos- pital care, medical services, or extended care services covered veterans may receive under this section if it is in the best medical interest of the veteran to receive such hospital care, medical services, or extended care services, as deter- mined by the veteran and the veteran’s health care provider. (2) No provision in this section may be con- strued to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or ex- tended care services. (o) OUTREACH REGARDING AVAILABILITY OF CARE AND SERVICES.—(1) The Secretary shall conduct outreach to inform veterans of the fol- lowing: (A) The conditions for care or services under subsections (d) and (e). Page 314 TITLE 38—VETERANS’ BENEFITS § 1703 (B) How to request such care or services. (C) How to appeal a denial of a request for such care or services using the clinical appeals process of the Veterans Health Administra- tion. (2) Upon enrollment of a veteran in the system of annual patient enrollment established and op- erated under section 1705 of this title, and not less frequently than every two years thereafter, the Secretary shall inform the veteran of infor- mation described in paragraph (1). (3) The Secretary shall ensure that informa- tion described in paragraph (1) is— (A) publicly displayed in each medical facil- ity of the Department; (B) prominently displayed on a website of the Department; and (C) included in other outreach campaigns and activities conducted by the Secretary. (p) ANNUAL REVIEW AND REPORT ON WAIVERS OF PAYMENT RATES.—(1) On an annual basis, the Secretary shall— (A) conduct a review of waivers of payment rates under subsection (i) for Third Party Ad- ministrators to identify whether such waivers help to alleviate community-specific chal- lenges, including scarcity of medical services associated with access to health care; and (B) submit to Congress a report on the re- sults of such review. (2) Each report under paragraph (1)(B) shall in- clude, with respect to the period covered by the report— (A) a statement, disaggregated by region, of the total number of waivers described in sub- paragraph (A) of such paragraph requested by Third Party Administrators; (B) a statement of the total number of such waivers that were— (i) granted by the Secretary; (ii) denied by the Secretary; or (iii) withdrawn by a Third Party Adminis- trator; (C) a description of the process for the re- view required under paragraph (1); (D) a statement, disaggregated by region, of the average time to process such waivers; (E) an assessment, disaggregated by region, of the extent to which such waivers that were granted by the Secretary improved access to health care for covered veterans; and (F) a description of trends, if any, identified by the Secretary with respect to such waivers. (3) In this subsection, the term ‘‘Third Party Administrator’’ has the meaning given such term in section 1703B of this title. (q) DEFINITIONS.—In this section: (1) The term ‘‘appropriate committees of Congress’’ means— (A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and (B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives. (2) The term ‘‘medical service line’’ means a clinic within a Department medical center. (Added Pub. L. 99–272, title XIX, § 19012(b)(1), Apr. 7, 1986, 100 Stat. 380, § 603; amended Pub. L. 99–166, title I, § 102(b)(1), Dec. 3, 1985, 99 Stat. 943; Pub. L. 99–272, title XIX, § 19012(c)(5)(A), Apr. 7, 1986, 100 Stat. 382; Pub. L. 100–322, title I, §§ 101(e)(3), 104, 112(a), May 20, 1988, 102 Stat. 492, 493, 499; Pub. L. 100–687, div. B, title XV, § 1503(a)(1), Nov. 18, 1988, 102 Stat. 4133; Pub. L. 102–54, § 14(b)(9), June 13, 1991, 105 Stat. 283; re- numbered § 1703 and amended Pub. L. 102–83, §§ 4(a)(1), (3)–(5), (b)(1), (2)(E), 5(a), (c)(1), Aug. 6, 1991, 105 Stat. 403–406; Pub. L. 102–585, title V, § 501, Nov. 4, 1992, 106 Stat. 4955; Pub. L. 104–262, title I, § 104(b), Oct. 9, 1996, 110 Stat. 3184; Pub. L. 108–422, title VI, § 601, Nov. 30, 2004, 118 Stat. 2396; Pub. L. 109–13, div. A, title VI, § 6080, May 11, 2005, 119 Stat. 302; Pub. L. 110–387, title VIII, § 802, Oct. 10, 2008, 122 Stat. 4141; Pub. L. 112–37, § 10(a), Oct. 5, 2011, 125 Stat. 396; Pub. L. 115–182, title I, § 101(a)(1), June 6, 2018, 132 Stat. 1395; Pub. L. 115–251, title II, §§ 201(a), 202, Sept. 29, 2018, 132 Stat. 3171, 3172; Pub. L. 117–328, div. U, title I, §§ 121, 125(b), Dec. 29, 2022, 136 Stat. 5415, 5418; Pub. L. 118–210, title I, §§ 102(a), 103(a), Jan. 2, 2025, 138 Stat. 2709, 2710.) Editorial Notes REFERENCES IN TEXT The Social Security Act, referred to in subsecs. (c)(1) and (i)(1), is act Aug. 14, 1935, ch. 531, 49 Stat. 620. Titles XI and XVIII of the Act are classified generally to sub- chapters XI (§ 1301 et seq.) and XVIII (§ 1395 et seq.), re- spectively, of chapter 7 of Title 42, The Public Health and Welfare. For complete classification of this Act to the Code, see section 1305 of Title 42 and Tables. The date of the enactment of the Caring for Our Vet- erans Act of 2018, referred to in subsecs. (d)(1)(C) and (m)(1), (3), is the date of enactment of Pub. L. 115–182, which was approved June 6, 2018. For the effective date specified in section 101(b) of the Caring for Our Veterans Act of 2018, referred to in sub- sec. (h)(5)(A), see section 101(b) of Pub. L. 115–182, which is set out as an Effective Date of 2018 Amendment note below. Section 372 of the National Organ Transplantation Act, referred to in subsec. (l)(2)(B), probably means sec- tion 372 of the Public Health Service Act, act July 1, 1944, ch. 373, which was enacted by section 201 of the National Organ Transplant Act, Pub. L. 98–507, and is classified to section 274 of Title 42, The Public Health and Welfare. AMENDMENTS 2025—Subsec. (o). Pub. L. 118–210, § 102(a)(2), added subsec. (o). Former subsec. (o) redesignated (p), then (q). Subsec. (p). Pub. L. 118–210, § 103(a)(2), added subsec. (p). Subsec. (q). Pub. L. 118–210, §§ 102(a)(1), 103(a)(1), re- designated subsec. (o) as (p), then (q). 2022—Subsec. (a)(4). Pub. L. 117–328, § 125(b), added par. (4). Subsec. (d)(4). Pub. L. 117–328, § 121, added par. (4). 2018—Pub. L. 115–182 amended section generally. Prior to amendment, section related to contracts for hospital care and medical services in non-Department facilities. Subsec. (h)(1). Pub. L. 115–251, § 201(a), designated ex- isting provisions as subpar. (A) and added subpar. (B). Subsec. (h)(5)(A). Pub. L. 115–251, § 202, substituted ‘‘the effective date specified in section 101(b)’’ for ‘‘the date of the enactment’’. 2011—Subsec. (d)(4). Pub. L. 112–37 substituted ‘‘Sep- tember 30, 2020’’ for ‘‘September 30, 2013’’. 2008—Subsec. (d)(4). Pub. L. 110–387 substituted ‘‘Sep- tember 30, 2013’’ for ‘‘September 30, 2008’’. 2005—Subsec. (d)(2). Pub. L. 109–13 substituted ‘‘shall be available, without fiscal year limitation, for the purposes’’ for ‘‘shall be available for the purposes’’. Page 315 TITLE 38—VETERANS’ BENEFITS § 1703 2004—Subsec. (d). Pub. L. 108–422 added subsec. (d). 1996—Subsec. (a). Pub. L. 104–262, § 104(b)(1), struck out ‘‘or 1712’’ after ‘‘, as authorized in section 1710’’ in introductory provisions. Subsec. (a)(2)(A). Pub. L. 104–262, § 104(b)(2)(A), sub- stituted ‘‘1710(a)(1)(B)’’ for ‘‘1712(a)(1)(B)’’. Subsec. (a)(2)(B). Pub. L. 104–262, § 104(b)(2)(B), added subpar. (B) and struck out former subpar. (B) which read as follows: ‘‘a veteran described in paragraph (2), (3), or (4) of section 1712(a) of this title, for a purpose described in section 1712(a)(5)(B) of this title;’’. Subsec. (a)(2)(C). Pub. L. 104–262, § 104(b)(2)(C), sub- stituted ‘‘section 1710(a)(2)(E) of this title, or a veteran who is in receipt of increased pension, or additional compensation or allowances based on the need of reg- ular aid and attendance or by reason of being perma- nently housebound (or who, but for the receipt of re- tired pay, would be in receipt of such pension, com- pensation, or allowance),’’ for ‘‘section 1712(a)(3) (other than a veteran who is a former prisoner of war) of this title’’. Subsec. (a)(7). Pub. L. 104–262, § 104(b)(3), substituted ‘‘1712(a)(1)(F)’’ for ‘‘1712(b)(1)(F)’’. 1992—Subsec. (a)(1)(C). Pub. L. 102–585 added subpar. (C). 1991—Pub. L. 102–83, § 5(a), renumbered section 603 of this title as this section. Pub. L. 102–83, § 4(a)(5), substituted ‘‘non-Depart- ment’’ for ‘‘non-Veterans’ Administration’’ in section catchline. Subsec. (a). Pub. L. 102–83, § 5(c)(1), substituted ‘‘1710 or 1712’’ for ‘‘610 or 612’’ in introductory provisions, ‘‘1712(a)(1)(B)’’ for ‘‘612(a)(1)(B)’’ in par. (2)(A), ‘‘1712(a)’’ for ‘‘612(a)’’ and ‘‘1712(a)(5)(B)’’ for ‘‘612(a)(5)(B)’’ in par. (2)(B), ‘‘1712(a)(3)’’ for ‘‘612(a)(3)’’ in par. (2)(C), ‘‘1720’’ for ‘‘620’’ in par. (3), and ‘‘1712(b)(1)(F)’’ for ‘‘612(b)(1)(F)’’ in par. (7). Pub. L. 102–83, § 4(b)(1), (2)(E), substituted ‘‘Sec- retary’’ for ‘‘Administrator’’ in introductory provisions and in par. (2)(C). Pub. L. 102–83, § 4(a)(5), substituted ‘‘non-Depart- ment’’ for ‘‘non-Veterans’ Administration’’ in introduc- tory provisions and in pars. (3) and (5). Pub. L. 102–83, § 4(a)(3), (4), substituted ‘‘Department’’ for ‘‘Veterans’ Administration’’ wherever appearing in introductory provisions and pars. (2), (3), (5), and (6). Subsec. (a)(2)(B). Pub. L. 102–54, § 14(b)(9)(A), struck out ‘‘section’’ before ‘‘paragraph’’. Subsec. (a)(7). Pub. L. 102–54, § 14(b)(9)(B), substituted ‘‘section 612(b)(1)(F)’’ for ‘‘section 612(b)(1)(G)’’. Subsec. (a)(8). Pub. L. 102–83, § 4(a)(1), substituted ‘‘administered by the Secretary’’ for ‘‘administered by the Veterans’ Administration’’. Subsec. (b). Pub. L. 102–83, § 4(b)(1), (2)(E), substituted ‘‘Secretary’’ for ‘‘Administrator’’ in two places. Pub. L. 102–83, § 4(a)(5), substituted ‘‘non-Depart- ment’’ for ‘‘non-Veterans’ Administration’’. Subsec. (c). Pub. L. 102–83, § 5(c)(1), substituted ‘‘1712A, 1720, 1720A, 1724, and 1732’’ for ‘‘612A, 620, 620A, 624, and 632’’. Pub. L. 102–83, § 4(b)(1), (2)(E), substituted ‘‘Sec- retary’’ for ‘‘Administrator’’ in two places. Pub. L. 102–54, § 14(b)(9)(C), inserted before period at end ‘‘(Public Law 100–322; 102 Stat. 501)’’. 1988—Subsec. (a). Pub. L. 100–322, § 104(b)(1), sub- stituted ‘‘furnish any of the following:’’ for ‘‘fur- nish—’’. Subsec. (a)(1). Pub. L. 100–322, § 104(b)(2), (3), sub- stituted ‘‘Hospital’’ for ‘‘hospital’’ and the period for semicolon at end. Subsec. (a)(2). Pub. L. 100–322, § 104(b)(2), (3), sub- stituted ‘‘Medical’’ for ‘‘medical’’ and the period for semicolon at end. Subsec. (a)(2)(B). Pub. L. 100–687 substituted ‘‘para- graph (2), (3), or (4) of section 612(a)’’ for ‘‘612(a)(4)’’, and ‘‘612(a)(5)(B)’’ for ‘‘612(a)(5)’’. Pub. L. 100–322, § 101(e)(3)(A), substituted ‘‘section 612(a)(4) of this title, for a purpose described in section 612(a)(5) of this title’’ for ‘‘section 612(f)(1)(A)(ii) of this title’’. Subsec. (a)(2)(C). Pub. L. 100–322, § 101(e)(3)(B), sub- stituted ‘‘section 612(a)(3) (other than a veteran who is a former prisoner of war)’’ for ‘‘section 612(g)’’. Subsec. (a)(3). Pub. L. 100–322, § 104(a)(1), (b)(2), (3), substituted ‘‘Hospital’’ for ‘‘hospital’’, inserted ‘‘or nursing home care under section 620 of this title’’, and substituted the period for semicolon at end. Subsec. (a)(4), (5). Pub. L. 100–322, § 104(b)(2), (3), sub- stituted ‘‘Hospital’’ for ‘‘hospital’’ and the period for semicolon at end. Subsec. (a)(6). Pub. L. 100–322, § 104(b)(2), (4), sub- stituted ‘‘Diagnostic’’ for ‘‘diagnostic’’ and the period for ‘‘; or’’. Subsec. (a)(7). Pub. L. 100–322, § 104(b)(2), substituted ‘‘Outpatient’’ for ‘‘outpatient’’. Subsec. (a)(8). Pub. L. 100–322, § 104(a)(2), added par. (8). Subsec. (c). Pub. L. 100–322, § 112(a), added subsec. (c). 1986—Subsec. (a)(5). Pub. L. 99–272, § 19012(c)(5)(A), made conforming amendment to Pub. L. 99–166, § 102(b)(1). See 1985 Amendment note below. 1985—Subsec. (a)(5). Pub. L. 99–166, § 102(b)(1), as amended by Pub. L. 99–272, § 19012(c)(5)(A), inserted ‘‘(other than the Commonwealth of Puerto Rico)’’ after ‘‘in a State’’ and substituted ‘‘contiguous States and the Commonwealth of Puerto Rico’’ for ‘‘contiguous States, but the authority of the Administrator under this paragraph with respect to the Commonwealth of Puerto Rico shall expire on September 30, 1988, and until such date the Administrator may, if necessary to prevent hardship, waive the applicability to the Com- monwealth of Puerto Rico of the restrictions in this paragraph with respect to hospital patient loads and the incidence of the furnishing of medical services’’. Statutory Notes and Related Subsidiaries EFFECTIVE DATE OF 2018 AMENDMENT Pub. L. 115–251, title II, § 201(b), Sept. 29, 2018, 132 Stat. 3172, provided that: ‘‘The amendments made by subsection (a) [amending this section] shall take effect on the effective date specified in section 101(b) of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (Public Law 115–182) [set out below].’’ Pub. L. 115–182, title I, § 101(b), June 6, 2018, 132 Stat. 1403, provided that: ‘‘Section 1703 of title 38, United States Code, as amended by subsection (a), shall take effect on the later of— ‘‘(1) the date that is 30 days after the date on which the Secretary of Veterans Affairs submits the report required under section 101(q)(2) of the Veterans Ac- cess, Choice, and Accountability Act of 2014 (Public Law 113–146; 38 U.S.C. 1701 note) [June 29, 2017]; or ‘‘(2) the date on which the Secretary promulgates regulations pursuant to subsection (c) [set out as a Regulations note below] [regulations effective June 6, 2019, see 84 F.R. 26278].’’ EFFECTIVE DATE OF 1988 AMENDMENT Pub. L. 100–687, div. B, title XV, § 1503(b), Nov. 18, 1988, 102 Stat. 4134, provided that: ‘‘The amendments made by subsection (a)(1) [amending this section] shall apply with respect to the furnishing of medical services by contract to veterans who apply to the Veterans’ Ad- ministration for medical services after June 30, 1988.’’ Pub. L. 100–322, title I, § 101(i), May 20, 1988, 102 Stat. 492, provided that: ‘‘The amendments made by this sec- tion [amending this section and sections 612 and 617 [now 1712 and 1717] of this title] shall apply with re- spect to the furnishing of medical services to veterans who apply for such services after June 30, 1988.’’ EFFECTIVE DATE OF 1985 AMENDMENT Pub. L. 99–166, title I, § 102(b)(1), Dec. 3, 1985, 99 Stat. 943, as amended by Pub. L. 99–272, title XIX, § 19012(c)(5)(A), Apr. 7, 1986, 100 Stat. 382, provided that the amendment made by that section is effective Oct. 1, 1988. Page 316 TITLE 38—VETERANS’ BENEFITS § 1703 REGULATIONS Pub. L. 115–182, title I, § 101(c), June 6, 2018, 132 Stat. 1403, provided that: ‘‘(1) IN GENERAL.—Not later than 1 year after the date of the enactment of this Act [June 6, 2018], the Sec- retary of Veterans Affairs shall promulgate regulations to carry out section 1703 of title 38, United States Code, as amended by subsection (a) of this section. ‘‘(2) UPDATES.— ‘‘(A) PERIODIC.—Before promulgating the regula- tions required under paragraph (1), the Secretary shall provide to the appropriate committees of Con- gress periodic updates to confirm the progress of the Secretary toward developing such regulations. ‘‘(B) FIRST UPDATE.—The first update under sub- paragraph (A) shall occur no later than 120 days from the date of the enactment of this Act. ‘‘(C) APPROPRIATE COMMITTEES OF CONGRESS DE- FINED.—In this paragraph, the term ‘appropriate com- mittees of Congress’ means— ‘‘(i) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and ‘‘(ii) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Rep- resentatives.’’ IMPLEMENTATION OF PROVISION OF CARE UNDER VET- ERANS COMMUNITY CARE PROGRAM UPON DETERMINA- TION OF ELIGIBILITY BY VETERAN AND VETERAN’S RE- FERRING CLINICIAN Pub. L. 118–210, title I, § 101, Jan. 2, 2025, 138 Stat. 2708, provided that: ‘‘(a) IN GENERAL.—During the period specified in sub- section (c), the Secretary of Veterans Affairs shall im- plement section 1703(d)(1)(E) of title 38, United States Code, in compliance with the implementing regulations for such section under section 17.4010(a)(5) of title 38, Code of Federal Regulations, such that the determina- tion of eligibility for care is final and shall be made by the veteran and the veteran’s referring clinician. ‘‘(b) CORRECTION OF ERRORS.—A covered veteran and the referring clinician of such veteran may correct any errors made with respect to a determination described in subsection (a). ‘‘(c) PERIOD SPECIFIED.—The period specified in this subsection is the two-year period beginning on the date that is 90 days after the date of the enactment of this Act [Jan. 2, 2025]. ‘‘(d) REPORT.—Not later than one year and not later than two years after the commencement of the period specified by subsection (c), the Secretary of Veterans Affairs shall submit to Congress a report on the care provided under section 1703(d)(1)(E) of title 38, United States Code, during the one-year period preceding the date of the report, including— ‘‘(1) the number of instances of care provided; ‘‘(2) the type of care provided; and ‘‘(3) the cost of such care. ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this section shall be construed to limit the Secretary’s authority to prescribe, amend, or rescind regulations under section 1703 of title 38, United States Code. ‘‘(f) COVERED VETERAN DEFINED.—In this section, the term ‘covered veteran’ has the meaning given that term in section 1703(b) of title 38, United States Code.’’ DEADLINE TO SUBMIT FIRST REPORT Pub. L. 118–210, title I, § 103(b), Jan. 2, 2025, 138 Stat. 2710, provided that: ‘‘The Secretary shall submit the first report required under subsection (p) of section 1703 of such title [title 38] (as added by subsection (a)) not later than 180 days after the date of the enactment of this Act [Jan. 2, 2025].’’ PILOT PROGRAM TO IMPROVE ADMINISTRATION OF CARE UNDER VETERANS COMMUNITY CARE PROGRAM Pub. L. 118–210, title I, § 105, Jan. 2, 2025, 138 Stat. 2713, provided that: ‘‘(a) ESTABLISHMENT.—Pursuant to section 1703E of title 38, United States Code, the Secretary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under such section, shall carry out a pilot program to seek to develop and imple- ment a plan— ‘‘(1) to provide monetary and non-monetary incen- tives to a covered health care provider— ‘‘(A) to allow the Secretary to see the scheduling system of the provider, to assess the availability of, and to assist in scheduling appointments for, vet- erans under the Veterans Community Care Pro- gram under section 1703 of such title, including through synchronous, asynchronous, and asyn- chronous assisted digital scheduling; ‘‘(B) to complete continuing professional edu- cational training available through the VHA TRAIN program (or any successor program or ini- tiative) regarding veteran cultural competency, the opioid safety initiative (or any successor program or initiative), and other subjects determined appro- priate by the Secretary; ‘‘(C) to improve methods of accounting for non- Department training that is equivalent or substan- tially similar to the continuing professional edu- cational training described in subparagraph (B); ‘‘(D) to improve the rate of the timely return to the Secretary of medical record documentation for care or services provided under the Veterans Com- munity Care Program; ‘‘(E) to improve the timeliness and quality of the delivery of care and services to veterans under such program; and ‘‘(F) to achieve other objectives determined ap- propriate by the Secretary; and ‘‘(2) to decrease the rate of no-show appointments under such program. ‘‘(b) REPORT.—Not later than one year after the date of the establishment of the pilot program under this section, and annually thereafter during the term of the pilot program, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that includes, with respect to the pe- riod covered by the report— ‘‘(1) an assessment of the extent to which— ‘‘(A) the system of the Department of Veterans Affairs for scheduling appointments for veterans under the Veterans Community Care Program has improved; ‘‘(B) the rate of timely return to the Secretary of medical record documentation described in sub- paragraph (D) of subsection (a)(1) has improved; ‘‘(C) the timeliness and quality of the delivery of care and services described in subparagraph (E) of such subsection has improved; and ‘‘(D) the frequency of no-show appointments de- scribed in paragraph (2) of such subsection de- creased; ‘‘(2) a list of the continuing professional edu- cational training courses under subparagraph (B) of such subsection available to covered health care pro- viders; ‘‘(3) the rate of participation in such continuing professional education training courses; and ‘‘(4) any other matter the Secretary determines ap- propriate. ‘‘(c) DEFINITIONS.—In this section: ‘‘(1) The term ‘covered health care provider’ means a health care provider— ‘‘(A) described in subsection (c) of section 1703 of title 38, United States Code, that furnishes care or services under the Veterans Community Care Pro- gram pursuant to a contract or agreement with a Third Party Administrator; or ‘‘(B) that otherwise furnishes care or services out- side of Department facilities pursuant to a contract or agreement with the Secretary of Veterans Af- fairs. ‘‘(2) The term ‘opioid safety initiative’ means the programs, processes, and guidelines of the Veterans Health Administration of the Department of Vet- Page 317 TITLE 38—VETERANS’ BENEFITS § 1703 erans Affairs relating to the management of opioid therapy and chronic pain. ‘‘(3) The term ‘Third Party Administrator’ means an entity that manages a network of health care pro- viders and performs administrative services related to such network under section 1703 of such title. ‘‘(4) The term ‘VHA TRAIN program’ means the free program of the Veterans Health Administration that offers veteran-specific continuing medical edu- cation courses.’’ PILOT PROGRAM ON CONSOLIDATING APPROVAL PROCESS OF DEPARTMENT OF VETERANS AFFAIRS FOR COVERED DENTAL CARE Pub. L. 118–210, title I, § 106, Jan. 2, 2025, 138 Stat. 2715, provided that: ‘‘(a) IN GENERAL.—Not later than 180 days after the date of the enactment of this Act [Jan. 2, 2025], the Sec- retary of Veterans Affairs, acting through the Center for Innovation for Care and Payment established under section 1703E of title 38, United States Code, shall carry out a pilot program under which the Secretary shall hire— ‘‘(1) general dentists at medical facilities of the De- partment of Veterans Affairs to manage approval by the Department of treatment plans requested by den- tal providers in providing covered dental care; and ‘‘(2) dental specialists at Veterans Integrated Serv- ice Networks of the Department to manage approval by the Department of treatment plans for specialty dental care requested by dental providers in pro- viding covered dental care. ‘‘(b) LOCATIONS.—The Secretary shall carry out the pilot program in not fewer than two Veterans Inte- grated Service Networks of the Department. ‘‘(c) REPORTS.— ‘‘(1) INITIAL REPORT.—Not later than one year after the date of the commencement of such pilot program, the Secretary shall submit to the Committees on Veterans’ Affairs of the Senate and the House of Rep- resentatives a report on the pilot program, that in- cludes— ‘‘(A) an identification of the Veterans Integrated Service Networks participating in such pilot pro- gram; ‘‘(B) a description of the implementation of such pilot program; ‘‘(C) an identification of any barriers or chal- lenges to implementing such pilot program; ‘‘(D) an assessment of the efficacy of hiring gen- eral dentists and dental specialists pursuant to such pilot program; ‘‘(E) aggregated feedback with respect to such pilot program from dentists of the Department in Veterans Integrated Service Networks partici- pating in such pilot program; and ‘‘(F) aggregated feedback from dental providers providing covered dental care within such Veterans Integrated Service Networks regarding any changes in the timeliness of treatment plan approvals by the Department. ‘‘(2) FINAL REPORT.—Not later than 90 days before the date of the completion of such pilot program, the Secretary shall submit to the Committees on Vet- erans’ Affairs of the Senate and the House of Rep- resentatives a report on the pilot program that— ‘‘(A) includes, with respect to the period covered by the report, each element of the report required under paragraph (1) described in subparagraphs (A) through (F) of such paragraph; ‘‘(B) includes recommendations of the Secretary on whether the pilot program should be— ‘‘(i) extended; ‘‘(ii) expanded; or ‘‘(iii) adopted throughout the Department; and ‘‘(C) indicates whether the Secretary requests ac- tion by Congress to make the pilot program perma- nent. ‘‘(d) SUNSET.—The authority to carry out the pilot program under this section shall terminate on the date that is two years after the date of the enactment of this Act. ‘‘(e) COVERED DENTAL CARE DEFINED.—In this section, the term ‘covered dental care’ means dental care pro- vided— ‘‘(1) under section 1703 of title 38, United States Code; or ‘‘(2) pursuant to a Veterans Care Agreement under section 1703A of such title.’’ INSPECTOR GENERAL ASSESSMENT OF IMPLEMENTATION OF VETERANS COMMUNITY CARE PROGRAM Pub. L. 118–210, title I, § 110, Jan. 2, 2025, 138 Stat. 2722, provided that: ‘‘(a) IN GENERAL.—Not later than 18 months after the date of the enactment of this Act [Jan. 2, 2025], and pe- riodically thereafter, the Inspector General shall assess the performance of the Department of Veterans Affairs in— ‘‘(1) appropriately identifying veterans eligible for care and services under section 1703 of title 38, United States Code; ‘‘(2) informing veterans of their eligibility for such care and services; and ‘‘(3) delivering such care and services in a timely manner. ‘‘(b) BRIEFING ON ASSESSMENTS.—Upon the submission of the assessment required by subsection (a), the In- spector General of the Department of Veterans Affairs shall provide to the Committees on Veterans[’] Affairs of the House of Representatives and the Senate a brief- ing on the results of such assessment.’’ PLAN REGARDING INFORMING VETERANS OF EXPECTED WAIT TIMES FOR APPOINTMENTS FOR CARE Pub. L. 117–328, div. U, title I, § 122, Dec. 29, 2022, 136 Stat. 5415, provided that: ‘‘(a) IN GENERAL.—Not later than October 1, 2023, the Secretary of Veterans Affairs shall develop a plan to ensure that veterans eligible for care or services pursu- ant to section 1703(d)(1) of title 38, United States Code, including veterans making their own appointments using advanced technology, are informed of the ex- pected number of days between the date on which the veteran requested care until— ‘‘(1) the date on which the veteran will be able to receive care through a non-Department of Veterans Affairs provider under such section; ‘‘(2) the date on which the veteran will be able to receive care through a provider of the Department; ‘‘(3) the date on which— ‘‘(A) the Department will schedule an appoint- ment for care through a non-Department provider under such section; or ‘‘(B) for veterans making their own appointments using advanced technology, the veteran would be able to schedule an appointment for care through a provider of the Department or through a non-De- partment provider under such section; ‘‘(4) the date on which the Department will sched- ule an appointment for care through a provider of the Department. ‘‘(b) IMPLEMENTATION.—The Secretary shall imple- ment the plan required under subsection (a) not later than three years after the date of the enactment of this Act [Dec. 29, 2022]. ‘‘(c) MATTERS TO BE INCLUDED.—The Secretary shall include in the plan required under subsection (a) a list of the information technology systems, contracting mechanisms, staff, legislative authorities, pilot pro- grams, and other components that the Secretary deter- mines necessary to implement the plan within the three-year implementation deadline under subsection (b), as well as their associated milestones and resource requirements. ‘‘(d) UPDATES.—Not less frequently than quarterly, the Secretary shall brief the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives and submit to Page 318 TITLE 38—VETERANS’ BENEFITS § 1703 those committees a report in writing regarding the sta- tus of the implementation of the plan required under subsection (a), to include an assessment of the progress of the Secretary in meeting the three-year implemen- tation deadline under subsection (b).’’ COMMUNITY CARE SELF-SCHEDULING PILOT PROGRAM Pub. L. 117–328, div. U, title I, §§ 131–134, Dec. 29, 2022, 136 Stat. 5419–5422, provided that: ‘‘SEC. 131. DEFINITIONS. ‘‘In this chapter [chapter 3 (§§ 131–134) of title I of div. U of Pub. L. 117–328, enacting this note]: ‘‘(1) APPROPRIATE CONGRESSIONAL COMMITTEES.—The term ‘appropriate congressional committees’ means— ‘‘(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and ‘‘(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Rep- resentatives. ‘‘(2) COVERED VETERAN.—The term ‘covered veteran’ means a covered veteran under section 1703(b) of title 38, United States Code. ‘‘(3) PILOT PROGRAM.—The term ‘pilot program’ means the pilot program required under section 132(a). ‘‘(4) VETERANS COMMUNITY CARE PROGRAM.—The term ‘Veterans Community Care Program’ means the program to furnish hospital care, medical services, and extended care services to covered veterans under section 1703 of title 38, United States Code. ‘‘SEC. 132. PILOT PROGRAM ESTABLISHING COM- MUNITY CARE APPOINTMENT SELF-SCHED- ULING TECHNOLOGY. ‘‘(a) PILOT PROGRAM.—Not later than one year after the date of the enactment of this Act [Dec. 29, 2022], the Secretary of Veterans Affairs shall commence a pilot program under which covered veterans eligible for hos- pital care, medical services, or extended care services under subsection (d)(1) of section 1703 of title 38, United States Code, may use a technology that has the capa- bilities specified in section 133(a) to schedule and con- firm medical appointments with health care providers participating in the Veterans Community Care Pro- gram. ‘‘(b) EXPANSION OR DEVELOPMENT OF NEW TECH- NOLOGY.—In carrying out the pilot program, the Sec- retary may expand capabilities of an existing appoint- ment self-scheduling technology of the Department of Veterans Affairs or purchase a new appointment self- scheduling technology. ‘‘(c) COMPETITION.—In contracting for the expansion of capabilities of an existing appointment self-sched- uling technology of the Department or the purchase of a new appointment self-scheduling technology under the pilot program, the Secretary shall comply with sec- tion 3301 of title 41, United States Code, and award any such contract not later than 270 days after the date of the enactment of this Act. ‘‘(d) SELECTION OF LOCATIONS.—The Secretary shall select not fewer than two Veterans Integrated Services Networks of the Department in which to carry out the pilot program. ‘‘(e) DURATION OF PILOT PROGRAM.— ‘‘(1) IN GENERAL.—Except as provided in paragraph (2), the Secretary shall carry out the pilot program for an 18-month period. ‘‘(2) EXTENSION.—The Secretary may extend the du- ration of the pilot program and may expand the selec- tion of Veterans Integrated Services Networks under subsection (d) if the Secretary determines that the pilot program is reducing the wait times of veterans seeking hospital care, medical services, or extended care services under the Veterans Community Care Program. ‘‘(f) OUTREACH.—The Secretary shall ensure that vet- erans participating in the Veterans Community Care Program in Veterans Integrated Services Networks in which the pilot program is being carried out are in- formed about the pilot program. ‘‘SEC. 133. APPOINTMENT SELF-SCHEDULING CA- PABILITIES. ‘‘(a) IN GENERAL.—The Secretary of Veterans Affairs shall ensure that the appointment self-scheduling tech- nology used in the pilot program includes the following capabilities: ‘‘(1) Capability to self-schedule, modify, and cancel appointments directly online for primary care, spe- cialty care, and mental health care under the Vet- erans Community Care Program with regard to each category of eligibility under section 1703(d)(1) of title 38, United States Code. ‘‘(2) Capability to support appointments for the pro- vision of health care under the Veterans Community Care Program regardless of whether such care is pro- vided in person or through telehealth services. ‘‘(3) Not fewer than two of the following capabili- ties: ‘‘(A) Capability to view appointment availability in real time to the extent practicable. ‘‘(B) Capability to load relevant patient informa- tion from the Decision Support Tool of the Depart- ment or any other information technology system of the Department used to determine the eligibility of veterans for health care under section 1703(d)(1) of title 38, United States Code. ‘‘(C) Capability to search for providers and facili- ties participating in the Veterans Community Care Program based on distance from the residential ad- dress of a veteran. ‘‘(D) Capability to filter provider results by clin- ical expertise, ratings, reviews, sex, languages spo- ken, and other criteria as determined by the Sec- retary. ‘‘(E) Capability to provide telephonic and elec- tronic contact information for all such providers that do not offer online scheduling at the time. ‘‘(F) Capability to store and print authorization letters for veterans for health care under the Vet- erans Community Care Program. ‘‘(G) Capability to provide prompts or reminders to veterans to schedule initial appointments or fol- low-up appointments. ‘‘(H) Capability to be used 24 hours per day, seven days per week. ‘‘(I) Capability to ensure veterans who self-sched- ule appointments through the appointment self- scheduling technology have scheduled such ap- pointment with a provider possessing the required specialty and clinical expertise. ‘‘(J) Capability to integrate with the Veterans Health Information Systems and Technology Archi- tecture of the Department and the health record de- ployed by the Electronic Health Record Moderniza- tion program, or any successor information tech- nology system or health record of the Department. ‘‘(K) Capability to integrate with information technology systems of Third Party Administrators. ‘‘(b) INDEPENDENT VALIDATION AND VERIFICATION.— ‘‘(1) IN GENERAL.—The Comptroller General of the United States shall evaluate whether the appoint- ment self-scheduling technology used in the pilot program includes the capabilities required under sub- section (a) and successfully performs such capabili- ties. ‘‘(2) BRIEFING.—Not later than 30 days after the date on which the Comptroller General completes the evaluation under paragraph (1), the Comptroller Gen- eral shall brief the appropriate congressional com- mittees on such evaluation. ‘‘(c) CERTIFICATION.—Not later than 18 months after commencement of the pilot program, the Secretary shall certify to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives whether the appointment self-scheduling technology used in the pilot program and any other patient self-scheduling technology devel- oped or used by the Department of Veterans Affairs to schedule appointments under the Veterans Community Care Program as of the date of the certification in- cludes the capabilities required under subsection (a). Page 319 TITLE 38—VETERANS’ BENEFITS § 1703 ‘‘(d) THIRD PARTY ADMINISTRATOR DEFINED.—In this section, the term ‘Third Party Administrator’ means an entity that manages a provider network and per- forms administrative services related to such network within the Veterans Community Care Program under section 1703 of title 38, United States Code. ‘‘SEC. 134. REPORT. ‘‘Not later than 180 days after the date of the enact- ment of this Act, and every 180 days thereafter, the Secretary of Veterans Affairs shall submit to the ap- propriate congressional committees a report that in- cludes— ‘‘(1) an assessment by the Secretary of the pilot program during the 180-day period preceding the date of the report, including— ‘‘(A) the cost of the pilot program; ‘‘(B) the volume of usage of the appointment self- scheduling technology under the pilot program; ‘‘(C) the quality of the pilot program; ‘‘(D) patient satisfaction with the pilot program; ‘‘(E) benefits to veterans of using the pilot pro- gram; ‘‘(F) the feasibility of allowing self-scheduling for different specialties under the pilot program; ‘‘(G) participation in the pilot program by health care providers under the Veterans Community Care Program; and ‘‘(H) such other findings and conclusions with re- spect to the pilot program as the Secretary con- siders appropriate; and ‘‘(2) such recommendations as the Secretary con- siders appropriate regarding— ‘‘(A) extension of the pilot program to other or all Veterans Integrated Service Networks of the De- partment of Veterans Affairs; and ‘‘(B) making the pilot program permanent.’’ SUPPORT BY DEPARTMENT OF VETERANS AFFAIRS OF MATERNITY CARE COORDINATION Pub. L. 117–69, §§ 2, 3, Nov. 30, 2021, 135 Stat. 1495, 1496, provided that: ‘‘SEC. 2. DEFINITIONS. ‘‘In this Act [enacting this note, provisions set out as a note under section 101 of this title, and provisions not classified to the Code]: ‘‘(1) MATERNAL MORTALITY.—The term ‘maternal mortality’ means a death occurring during pregnancy or within a one-year period after pregnancy that is caused by pregnancy-related or childbirth complica- tions, including suicide, overdose, or other death re- sulting from a mental health or substance use dis- order attributed to or aggravated by pregnancy-re- lated or childbirth complications. ‘‘(2) POSTPARTUM.—The term ‘postpartum’, with re- spect to an individual, means the one-year period be- ginning on the last day of the pregnancy of the indi- vidual. ‘‘(3) PREGNANCY-ASSOCIATED DEATH.—The term ‘pregnancy-associated death’ means the death of a pregnant or postpartum individual, by any cause, that occurs during pregnancy or within one year fol- lowing pregnancy, regardless of the outcome, dura- tion, or site of the pregnancy. ‘‘(4) PREGNANCY-RELATED DEATH.—The term ‘preg- nancy-related death’ means the death of a pregnant or postpartum individual that occurs during preg- nancy or within one year following pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated con- dition by the physiologic effects of pregnancy. ‘‘(5) RACIAL AND ETHNIC MINORITY GROUP.—The term ‘racial and ethnic minority group’ has the meaning given that term in section 1707(g)(1) of the Public Health Service Act (42 U.S.C. 300u–6(g)(1)). ‘‘(6) SEVERE MATERNAL MORBIDITY.—The term ‘se- vere maternal morbidity’ means a health condition, including a mental health condition or substance use disorder, attributed to or aggravated by pregnancy or childbirth that results in significant short-term or long-term consequences to the health of the indi- vidual who was pregnant. ‘‘SEC. 3. SUPPORT BY DEPARTMENT OF VETERANS AFFAIRS OF MATERNITY CARE COORDINA- TION. ‘‘(a) PROGRAM ON MATERNITY CARE COORDINATION.— ‘‘(1) IN GENERAL.—The Secretary of Veterans Affairs shall carry out the maternity care coordination pro- gram described in Veterans Health Administration Directive 1330.03. ‘‘(2) TRAINING AND SUPPORT.—In carrying out the program under paragraph (1), the Secretary shall pro- vide to community maternity care providers training and support with respect to the unique needs of preg- nant and postpartum veterans, particularly regarding mental and behavioral health conditions relating to the service of those veterans in the Armed Forces. ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.— ‘‘(1) IN GENERAL.—There is authorized to be appro- priated to the Secretary $15,000,000 for fiscal year 2022 for the program under subsection (a)(1). ‘‘(2) SUPPLEMENT NOT SUPPLANT.—Amounts author- ized under paragraph (1) are authorized in addition to any other amounts authorized for maternity health care and coordination for the Department of Veterans Affairs. ‘‘(c) DEFINITIONS.—In this section: ‘‘(1) COMMUNITY MATERNITY CARE PROVIDERS.—The term ‘community maternity care providers’ means maternity care providers located at non-Department facilities who provide maternity care to veterans under section 1703 of title 38, United States Code, or any other law administered by the Secretary of Vet- erans Affairs. ‘‘(2) NON-DEPARTMENT FACILITIES.—The term ‘non- Department facilities’ has the meaning given that term in section 1701 of title 38, United States Code.’’ ADMINISTRATION OF NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE Pub. L. 116–315, title III, § 3103, Jan. 5, 2021, 134 Stat. 5004, provided that: ‘‘(a) CERTIFICATION OF PROPER ADMINISTRATION OF NON-DEPARTMENT CARE.— ‘‘(1) REVIEW.— ‘‘(A) IN GENERAL.—The Secretary of Veterans Af- fairs shall conduct a review of the staffing, train- ing, and other requirements necessary to admin- ister section 1703 of title 38, United States Code. ‘‘(B) ELEMENTS.—The review conducted under subparagraph (A) shall include, with respect to each medical facility of the Department of Veterans Af- fairs— ‘‘(i) an assessment of the type of positions re- quired to be staffed at the medical facility; ‘‘(ii) the number of such positions authorized; ‘‘(iii) the number of such positions funded; ‘‘(iv) the number of such positions filled; and ‘‘(v) the number of additional such positions re- quired to be authorized. ‘‘(2) SUBMITTAL TO CONGRESS.—Not later than 180 days after the date of the enactment of this Act [Jan. 5, 2021], and every 180 days thereafter, 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) the results of the review conducted under paragraph (1); and ‘‘(B) a certification that the Secretary has estab- lished all staffing, training, and other requirements required to be reviewed under such paragraph. ‘‘(b) SCHEDULING OF APPOINTMENTS.— ‘‘(1) MEASUREMENT OF TIMELINESS FOR EACH FACIL- ITY.—Not later than 120 days after the date of the en- actment of this Act, the Secretary shall measure, with respect to referrals for non-Department health care originating from medical facilities of the De- partment, for each such facility— Page 320 TITLE 38—VETERANS’ BENEFITS § 1703 ‘‘(A) the period of time between— ‘‘(i) the date that a clinician of the Department determines that a veteran requires care, or a vet- eran presents to the Department requesting care, and the date that the referral for care is sent to a non-Department health care provider; ‘‘(ii) the date that the referral for care is sent to a non-Department health care provider and the date that a non-Department health care provider accepts the referral; ‘‘(iii) the date that a non-Department health care provider accepts the referral and the date that the referral to a non-Department health care provider is completed; ‘‘(iv) the date that the referral to a non-Depart- ment health care provider is completed and the date that an appointment with a non-Department health care provider is made; and ‘‘(v) the date that an appointment with a non- Department health care provider is made and the date that an appointment with a non-Department health care provider occurs; and ‘‘(B) any other period of time that the Secretary determines necessary to measure. ‘‘(2) SUBMISSIONS TO CONGRESS.— ‘‘(A) IN GENERAL.—Not later than one year after the date of the enactment of this Act, the Sec- retary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Vet- erans’ Affairs of the House of Representatives the data measured under paragraph (1), disaggregated by medical facility. ‘‘(B) UPDATE.—Not less frequently than biweekly, the Secretary shall update the data submitted under subparagraph (A). ‘‘(c) COMPTROLLER GENERAL REPORT.— ‘‘(1) REVIEW.—Beginning not later than one year after the date of the enactment of this Act [Jan. 5, 2021], the Comptroller General of the United States shall review compliance by the Secretary with the re- quirements of this section, including a review of the validity and reliability of data submitted by the Sec- retary under subsection (b)(2). ‘‘(2) REPORT.—Not later than three years after the date of the enactment of this Act, the Comptroller General shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives the results of the review conducted under paragraph (1).’’ ESTABLISHMENT OF WOMEN VETERAN TRAINING MODULE FOR NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH CARE PROVIDERS Pub. L. 116–315, title V, § 5203, Jan. 5, 2021, 134 Stat. 5034, provided that: ‘‘(a) IN GENERAL.—Not later than one year after the date of the enactment of this Act [Jan. 5, 2021], the Sec- retary of Veterans Affairs shall establish and make available to community providers a training module that is specific to women veterans. ‘‘(b) TRAINING MATERIALS PROVIDED.—Under the training module established and made available to community providers under subsection (a), the Sec- retary shall provide to community providers the same training materials relating to treatment of women vet- erans that is provided to health care providers of the Department of Veterans Affairs to ensure that all health care providers treating women veterans have ac- cess to the same materials to support competency throughout the community. ‘‘(c) ADMINISTRATION OF TRAINING MODULE.—The Sec- retary shall administer the training module established under subsection (a) to community providers through an internet website of the Department. ‘‘(d) ANNUAL REPORT.—Not later than one year after the establishment of the training module under sub- section (a), and annually thereafter, the Secretary shall submit to Congress a report on— ‘‘(1) the utilization by community providers of the training module; and ‘‘(2) the effectiveness of the training module. ‘‘(e) DEFINITIONS.—In this section: ‘‘(1) COMMUNITY PROVIDER.—The term ‘community provider’ means a non-Department of Veterans Af- fairs health care provider who provides preauthorized health care to veterans under the laws administered by the Secretary of Veterans Affairs. ‘‘(2) PREAUTHORIZED HEALTH CARE.—The term ‘preauthorized health care’ means health care pro- vided to a veteran that is authorized by the Secretary before being provided.’’ CONTINUITY OF EXISTING AGREEMENTS Pub. L. 115–182, title I, § 101(d), June 6, 2018, 132 Stat. 1403, provided that: ‘‘(1) IN GENERAL.—Notwithstanding section 1703 of title 38, United States Code, as amended by subsection (a), the Secretary of Veterans Affairs shall continue all contracts, memorandums of understanding, memoran- dums of agreements, and other arrangements that were in effect on the day before the date of the enactment of this Act [June 6, 2018] between the Department of Vet- erans Affairs and the American Indian and Alaska Na- tive health care systems as established under the terms of the Department of Veterans Affairs and Indian Health Service Memorandum of Understanding, signed October 1, 2010, the National Reimbursement Agree- ment, signed December 5, 2012, arrangements under sec- tion 405 of the Indian Health Care Improvement Act (25 U.S.C. 1645), and agreements entered into under sec- tions 102 and 103 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113–146) [38 U.S.C. 1701 note]. ‘‘(2) MODIFICATIONS.—Paragraph (1) shall not be con- strued to prohibit the Secretary and the parties to the contracts, memorandums of understanding, memoran- dums of agreements, and other arrangements described in such paragraph from making such changes to such contracts, memorandums of understanding, memoran- dums of agreements, and other arrangements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts, memorandums of un- derstanding, memorandums of agreements, and other arrangements.’’ DEMONSTRATION PROJECTS ON ALTERNATIVES FOR EXPANDING CARE FOR VETERANS IN RURAL AREAS Pub. L. 111–163, title III, § 303, May 5, 2010, 124 Stat. 1149, provided that: ‘‘(a) IN GENERAL.—The Secretary of Veterans Affairs may, through the Director of the Office of Rural Health, carry out demonstration projects to examine the feasibility and advisability of alternatives for ex- panding care for veterans in rural areas, which may in- clude the following: ‘‘(1) Establishing a partnership between the Depart- ment of Veterans Affairs and the Centers for Medi- care and Medicaid Services of the Department of Health and Human Services to coordinate care for veterans in rural areas at critical access hospitals (as designated or certified under section 1820 of the So- cial Security Act (42 U.S.C. 1395i–4)). ‘‘(2) Establishing a partnership between the Depart- ment of Veterans Affairs and the Department of Health and Human Services to coordinate care for veterans in rural areas at community health centers. ‘‘(3) Expanding coordination between the Depart- ment of Veterans Affairs and the Indian Health Serv- ice to expand care for Indian veterans. ‘‘(b) GEOGRAPHIC DISTRIBUTION.—The Secretary shall ensure that the demonstration projects carried out under subsection (a) are located at facilities that are geographically distributed throughout the United States. ‘‘(c) REPORT.—Not later than 2 years after the date of the enactment of this Act [May 5, 2010], the Secretary shall submit a report on the results of the demonstra- tion projects carried out under subsection (a) to— ‘‘(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and Page 321 TITLE 38—VETERANS’ BENEFITS § 1703A ‘‘(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Rep- resentatives. ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There is au- thorized to be appropriated to carry out this section $5,000,000 for fiscal year 2010 and each fiscal year there- after.’’ PILOT PROGRAM OF ENHANCED CONTRACT CARE AU- THORITY FOR HEALTH CARE NEEDS OF VETERANS IN HIGHLY RURAL AREAS Pub. L. 110–387, title IV, § 403, Oct. 10, 2008, 122 Stat. 4124, as amended by Pub. L. 111–163, title III, § 308, May 5, 2010, 124 Stat. 1155; Pub. L. 113–146, title I, § 104, Aug. 7, 2014, 128 Stat. 1766; Pub. L. 113–175, title IV, § 409(h), Sept. 26, 2014, 128 Stat. 1908; Pub. L. 114–223, div. A, title II, § 242, Sept. 29, 2016, 130 Stat. 884, provided that: ‘‘(a) PILOT PROGRAM REQUIRED.— ‘‘(1) IN GENERAL.—The Secretary of Veterans Affairs shall conduct a pilot program under which the Sec- retary provides covered health services to covered veterans through qualifying non-Department of Vet- erans Affairs health care providers. ‘‘(2) COMMENCEMENT.—The Secretary shall com- mence the conduct of the pilot program on the date that is 120 days after the date of the enactment of this Act [Oct. 10, 2008]. ‘‘(3) DURATION.—A veteran may receive health serv- ices under this section during the period beginning on the date specified in paragraph (2) and ending on Sep- tember 30, 2017. ‘‘(4) PROGRAM LOCATIONS.—The Secretary shall carry out the pilot program at locations in the fol- lowing Veterans Integrated Service Networks (and such other locations as the Secretary considers ap- propriate): ‘‘(A) Veterans Integrated Service Network 1. ‘‘(B) Veterans Integrated Service Network 6. ‘‘(C) Veterans Integrated Service Network 15. ‘‘(D) Veterans Integrated Service Network 18. ‘‘(E) Veterans Integrated Service Network 19. ‘‘(b) COVERED VETERANS.—For purposes of the pilot program under this section, a covered veteran is any veteran who— ‘‘(1) is— ‘‘(A) enrolled in the system of patient enrollment established under section 1705(a) of title 38, United States Code, as of August 1, 2014; or ‘‘(B) eligible for health care under section 1710(e)(3) of such title; and ‘‘(2) resides in a location that is— ‘‘(A) more than 60 minutes driving distance from the nearest Department health care facility pro- viding primary care services, if the veteran is seek- ing such services; ‘‘(B) more than 120 minutes driving distance from the nearest Department health care facility pro- viding acute hospital care, if the veteran is seeking such care; or ‘‘(C) more than 240 minutes driving distance from the nearest Department health care facility pro- viding tertiary care, if the veteran is seeking such care. ‘‘(c) COVERED HEALTH SERVICES.—For purposes of the pilot program under this section, a covered health serv- ice with respect to a covered veteran is any hospital care, medical service, rehabilitative service, or pre- ventative health service that is authorized to be pro- vided by the Secretary to the veteran under chapter 17 of title 38, United States Code, or any other provision of law. ‘‘(d) QUALIFYING NON-DEPARTMENT HEALTH CARE PRO- VIDERS.—For purposes of the pilot program under this section, an entity or individual is a qualifying non-De- partment health care provider of a covered health serv- ice if the Secretary determines that the entity or indi- vidual is qualified to furnish such service to veterans under the pilot program. ‘‘(e) ELECTION.—A covered veteran seeking to be pro- vided covered health services under the pilot program under this section shall submit to the Secretary an ap- plication therefor in such form, and containing such in- formation as the Secretary shall specify for purposes of the pilot program. ‘‘(f) PROVISION OF SERVICES THROUGH CONTRACT.—The Secretary shall provide covered health services to vet- erans under the pilot program under this section through contracts with qualifying non-Department health care providers for the provision of such services. ‘‘(g) EXCHANGE OF MEDICAL INFORMATION.—In con- ducting the pilot program under this section, the Sec- retary shall develop and utilize a functional capability to provide for the exchange of appropriate medical in- formation between the Department and non-Depart- ment health care providers providing health services under the pilot program. ‘‘(h) APPOINTMENTS.—In carrying out the pilot pro- gram under this section, the Secretary shall ensure that medical appointments for covered veterans— ‘‘(1) are scheduled not later than 5 days after the date on which the appointment is requested; and ‘‘(2) occur not later than 30 days after such date. ‘‘(i) OUTREACH.—The Secretary shall ensure that cov- ered veterans are informed about the pilot program under this section. ‘‘(j) USE OF EXISTING CONTRACTS.—Notwithstanding any provision of law relating to the use of competitive procedures in entering into contracts, in carrying out the pilot program under this section after the date of the enactment of the Veterans Access, Choice, and Ac- countability Act of 2014 [Aug. 7, 2014], the Secretary shall make use of contracts entered into under this sec- tion before such date or may enter into new contracts. ‘‘(k) REPORTS.—Not later than the 30 days after the end of each year in which the pilot program under this section is conducted, the Secretary shall submit to the Committee of Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Rep- resentatives a report which includes— ‘‘(1) the assessment of the Secretary of the pilot program during the preceding year, including its cost, volume, quality, patient satisfaction, benefit to veterans, and such other findings and conclusions with respect to pilot program as the Secretary con- siders appropriate; and ‘‘(2) such recommendations as the Secretary con- siders appropriate regarding— ‘‘(A) the continuation of the pilot program; ‘‘(B) extension of the pilot program to other or all Veterans Integrated Service Networks of the De- partment; and ‘‘(C) making the pilot program permanent.’’ RATIFICATION OF MEDICAL SERVICES CONTRACTS Section 1503(c) of Pub. L. 100–687 ratified actions of the Administrator in contracting with facilities other than Veterans’ Administration facilities for furnishing medical services incident to treatment of certain vet- erans receiving hospital, nursing home, or domiciliary care, who applied for such services during the period beginning July 1, 1988, and ending Nov. 18, 1988. PUERTO RICO CONTRACT CARE; LIMITATION ON INCURRING OF OBLIGATIONS Pub. L. 99–166, title I, § 102(b)(2)–(5), Dec. 3, 1985, 99 Stat. 943, as amended by Pub. L. 99–272, title XIX, § 19012(c)(5)(B), Apr. 7, 1986, 100 Stat. 382, limited Admin- istrator’s authority to incur obligations for medical services for veterans residing in Puerto Rico during fis- cal years 1986 to 1988. § 1703A. Agreements with eligible entities or pro- viders; certification processes (a) AGREEMENTS AUTHORIZED.—(1)(A) When hospital care, a medical service, or an extended care service required by a covered individual who is entitled to such care or service under this chapter is not feasibly available to the covered