119-hr668

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 668 Introduced in House

    (IH) ]

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119th CONGRESS
 1st Session
 H. R. 668

 To require the Secretary of Veterans Affairs to carry out a pilot 
 program to coordinate, navigate, and manage care and benefits for 
veterans enrolled in both the Medicare program and the system of annual 
 patient enrollment of the Department of Veterans Affairs.

_______________________________________________________________________

 IN THE HOUSE OF REPRESENTATIVES

 January 23, 2025

Mr. Ciscomani (for himself, Mr. Davis of North Carolina, and Mr. Turner 
 of Ohio) introduced the following bill; which was referred to the 
 Committee on Veterans' Affairs

_______________________________________________________________________

 A BILL

 To require the Secretary of Veterans Affairs to carry out a pilot 
 program to coordinate, navigate, and manage care and benefits for 
veterans enrolled in both the Medicare program and the system of annual 
 patient enrollment of the Department of Veterans Affairs.

 Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

 This Act may be cited as the ``Coordinating Care for Senior 
Veterans and Wounded Warriors Act''.

SEC. 2. PILOT PROGRAM ON COORDINATION OF CARE BETWEEN DEPARTMENT OF 
 VETERANS AFFAIRS AND MEDICARE PROGRAM.

    (a) In General.--The Secretary, in consultation with the Secretary 
of Health and Human Services, shall carry out a pilot program (in this 
section referred to as the ``pilot program'') to coordinate, navigate, 
and manage care and benefits for covered veterans.

    (b) 

=== Purposes ===
-The purposes of the pilot program are as follows:

    (1) To improve access to health care services for covered 
 veterans at medical facilities of the Department of Veterans 
 Affairs, from health care providers under the Veterans 
 Community Care Program under 

section 1703 of title 38, United 
 States Code, from health care providers with which the 
 Department has established a Veterans Care Agreement under 
 

section 1703A of such title, and from health care providers 
 participating in the Medicare program under title XVIII of the 
 Social Security Act (42 U.S.C. 1395 et seq.).

    (2) To improve outcomes of care received by covered 
 veterans.

    (3) To improve quality of care received by covered 
 veterans.

    (4) To lower costs of care received by covered veterans.

    (5) To eliminate gaps in care and duplication of services 
 and expenses for covered veterans.

    (6) To improve care coordination for covered veterans, 
 including coordination of patient information and medical 
 records between providers.
            (c) Administration.--

    (1) In general.--The Secretary shall carry out the pilot 
 program through the Center for Innovation for Care and Payment 
 of the Department of Veterans Affairs.

    (2) Locations.--The Secretary shall carry out the pilot 
 program in not less than three but not more than five Veterans 
 Integrated Service Networks with a large number of covered 
 veterans and varying degrees of urbanization, including--
        (A) locations that are in rural or highly rural 
 areas, as determined through the use of the Rural-Urban 
 Commuting Areas coding system of the Department of 
 Agriculture; and
        (B) locations that are medically underserved.
            (d) Case Manager.--

    (1) Assignment of case manager.--In carrying out the pilot 
 program, the Secretary shall assign each covered veteran 
 participating in the pilot program a case manager responsible 
 for developing an individualized needs assessment for such 
 veteran and, based on such assessment, a care coordination plan 
 with defined treatment goals.

    (2) Accessing services.--A case manager assigned to a 
 covered veteran under paragraph

    (1) is responsible for 
 assisting such veteran in accessing services needed by such 
 veteran and navigating the systems of care under the laws 
 administered by the Secretary and under the Medicare program 
 under title XVIII of the Social Security Act (42 U.S.C. 1395 et 
 seq.).

    (e) Use of Existing Models.--In designing the pilot program, the 
Secretary shall, to the extent practicable, use existing models, 
including value-based care models, used by commercial health care 
programs to improve access, health outcomes, quality, and customer 
experience and lower per capita costs.

    (f) Contracting With Private Sector Entities.--

    (1) In general.--The Secretary shall, to the greatest 
 extent practicable, contract with private sector entities 
 carrying out commercial health care programs for assistance in 
 designing, implementing, and managing care and benefits under 
 the pilot program, to include providing care coordination.

    (2) Notification.--If the Secretary determines that 
 contracting with private sector entities under paragraph

    (1) is 
 not practicable, the Secretary shall submit to the Committee on 
 Veterans' Affairs of the Senate and the Committee on Veterans' 
 Affairs of the House of Representatives--
        (A) a notification of that determination;
        (B) a description of the steps the Secretary has 
 taken to contract with a private sector entity;
            (C) a justification for why the Secretary has 
 determined that contracting with a private sector 
 entity is not practicable; and
            (D) a plan for how the Secretary will carry out the 
 pilot program without contracting with a private sector 
 entity, including through the use of employees of the 
 Department of Veterans Affairs or other government 
 agencies, nonprofit organizations, or other entities.

    (g) Metrics.--

    (1) In general.--The Secretary shall track metrics under 
 the pilot program, including the following:
        (A) The number of veterans participating in the 
 pilot program, disaggregated by Veterans Integrated 
 Service Network.
        (B) Reliance on health care services administered 
 by the Secretary.
            (C) Reliance on health care services administered 
 under the Medicare program under title XVIII of the 
 Social Security Act (42 U.S.C. 1395 et seq.).
            (D) Quality of care, including patient outcomes.
        (E) Cost of care.
        (F) Access to care, including under the designated 
 access standards developed by the Secretary under 
 

section 1703B of title 38, United States Code.
        (G) Patient satisfaction.
        (H) Provider satisfaction.
            (I) Care coordination, including timely information 
 sharing and medical documentation return.

    (2) Elements.--In tracking metrics under paragraph

    (1) , the 
 Secretary shall track information relating to--
        (A) whether care received by a covered veteran is 
 related to a service-connected disability (as defined 
 in 

section 101 of title 38, United States Code);
        (B) the priority group under 

section 1705

    (a) of 
 title 38, United States Code, through which each 
 covered veteran was enrolled in the system of annual 
 patient enrollment of the Department of Veterans 
 Affairs under such section;
            (C) the type of care and services provided to 
 covered veterans; and
            (D) the demographics of covered veterans 
 participating in the pilot program, including age.

    (h) Duration.--The Secretary shall carry out the pilot program for 
a three-year period beginning on the commencement of the pilot program.
            (i) Reports.--

    (1) Development, implementation, results, and design of 
 pilot program.--
        (A) In general.--Not less frequently than quarterly 
 during the two-year period beginning on the date of the 
 enactment of this Act, the Secretary shall submit to 
 the Committee on Veterans' Affairs of the Senate and 
 the Committee on Veterans' Affairs of the House of 
 Representatives a report on the development, 
 implementation, results, and design of the pilot 
 program, including information on the metrics tracked 
 under subsection

    (g) .
        (B) Final design.--One of the reports required 
 under subparagraph
        (A) shall contain a description of 
 the final design of the pilot program.

    (2) Results of pilot program.--Not later than one year 
 after the submission of the final report under paragraph

    (1) , 
 and not less frequently than annually thereafter during the 
 duration of the pilot program, the Secretary shall submit to 
 the Committee on Veterans' Affairs of the Senate and the 
 Committee on Veterans' Affairs of the House of Representatives 
 a report on the results of the pilot program.

    (3) Final report.--Not later than 180 days before the 
 termination of the pilot program, the Secretary shall submit to 
 the Committee on Veterans' Affairs of the Senate and the 
 Committee on Veterans' Affairs of the House of Representatives 
 a final report on the pilot program, which shall include the 
 recommendation of the Secretary for whether the pilot program 
 should be extended or made permanent.

    (j) 

=== Definitions. ===
-In this section:

    (1) Covered veteran.--The term ``covered veteran'' means a 
 veteran who is enrolled in both the Medicare program under 
 title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
 and the system of annual patient enrollment of the Department 
 of Veterans Affairs under 

section 1705

    (a) of title 38, United 
 States Code.

    (2) Secretary.--The term ``Secretary'' means the Secretary 
 of Veterans Affairs.
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