Sec. 402. Authority for Department of Veterans Affairs Center for Innovation for Care and Payment
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Subchapter I of chapter 17, as amended by section 122, is further amended by inserting after section 1703E, as added by section 122, the following new section: There is established within the Department a Center for Innovation for Care and Payment (in this section referred to as the Center ). The Secretary, acting through the Center, may carry out such pilot programs as appropriate to develop new, innovative approaches to testing payment and service delivery models to reduce expenditures while preserving or enhancing the quality of care furnished by the Department.
The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models improve the access to and quality, timeliness, and patient satisfaction of such care and services, as well as the cost savings associated with such models. The Secretary shall test models where the Secretary determines that there is evidence that the model addresses a defined population for which there are deficits care leading to poor clinical outcomes or potentially avoidable expenditures.
The Secretary shall focus on models expected to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter. The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act ( 42 U.S.C. 1315a(b)(2)(B) ). In selecting models for testing, the Secretary may consider the following additional factors: Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of applicable individuals.
Whether the model places the applicable individual, including family members and other caregivers of the applicable individual, at the center of the care team of the applicable individual. Whether the model uses technology or new systems to coordinate care over time and across settings. Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models. Models tested under this section may not be designed in such a way that would allow the United States to recover or collect reasonable charges from a Federal health care program for care or services furnished by the Secretary to veterans under pilot programs carried out under this section.
In this paragraph, the term Federal health care program means— an insurance program described in section 1811 of the Social Security Act ( 42 U.S.C. 1395c ) or established by section 1831 of such Act ( 42 U.S.C. 1395j ); or a State plan for medical assistance approved under title XIX of such Act ( 42 U.S.C. 1396 et seq.); or a TRICARE program operated under sections 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10. Pilot programs carried out by the Secretary under this section shall terminate no later than five years after their commencement.
The Secretary shall ensure that pilot programs carried out under this section occur in different areas that are appropriate for the intended purposes of the pilot program. Funding for pilot programs carried out by the Secretary under this section will be derived from appropriations provided in advance in appropriations Acts for the Veterans Health Administration and from appropriations provided for information technology systems. The Secretary shall publish information about such pilot programs in the Federal Register, and shall take reasonable actions to provide direct notice to veterans eligible to participate in a pilot program operated under this section.
Subject to reporting under paragraph
(2)and approval under paragraph (3), in implementing the pilot programs under this section, the Secretary may waive such requirements in subchapters I, II, and III of this chapter as may be necessary solely for the purposes of carrying out this section with respect to testing models described in subsection (a). Before waiving any authority under paragraph (1), the Secretary shall submit a report to the Speaker of the House of Representatives, the minority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the Senate, and each standing committee with jurisdiction under the rules of the Senate of the House of Representatives to report a bill to amend the provision or provisions of law that would be waived by the Department describing in detail the following: The specific authorities to be waived under the pilot program. The standard or standards to be used in the pilot program in lieu of the waived authorities. The reasons for such waiver or waivers. A description of the metric or metrics the Secretary will use to determine the effect of the waiver or waivers upon the access to and quality, timeliness, or patient satisfaction of care and services furnished through the pilot program. The anticipated cost savings, if any, of the pilot program. The schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program. The schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent. The estimated budget of the pilot program. Upon receipt of a report submitted under paragraph (2), each House shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the House of Representatives or the Senate to report a bill to amend the provision or provisions of law that would be waived by the Department under this subsection. The waiver requested by the Secretary under paragraph
(2)shall be considered approved under this paragraph if there is enacted into law a bill or joint resolution approving such request in its entirety. Such bill or joint resolution shall be passed by recorded vote to reflect the vote of each member of Congress thereon. The provisions of this paragraph are enacted by the Congress— as an exercise of the rulemaking power of the Senate and the House of Representatives and as such shall be considered as part of the rules of each House, and shall supersede other rules only to the extent that they are inconsistent therewith; and with full recognition of the constitutional right of either House to change the rules (so far as they relate to the procedures of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House. During the 60-calendar-day period beginning on the date on which the Secretary submits the report described in paragraph
(2)to Congress, it shall be in order as a matter of highest privilege in each House of Congress to consider a bill or joint resolution, if offered by the majority leader of such House (or a designee), approving such request in its entirety. The waiver provisions in subsection
(f)shall not be available unless the Secretary submits the first proposal, in accordance with the requirements in subsection (f), for a pilot program within 18 months of the date of the enactment of the Veterans Community Care and Access Act of 2017 . Notwithstanding section 502 of this title, decisions by the Secretary under this section shall, consistent with section 511 of this title, be final and conclusive and may not be reviewed by any other official or by any court, whether by an action in the nature of mandamus or otherwise. If the Secretary determines that the pilot program is not improving the quality of care or producing cost savings, the Secretary shall— propose a modification to the pilot program in the interim report that shall also be considered a report under subsection (f)(2)(A) and shall be subject to the terms and conditions of subsection (f)(2); or terminate such pilot program within 30 days of submitting the interim report to Congress. If the Secretary terminates the pilot program under subparagraph (A)(ii), for purposes of clauses
(vi)and
(vii)of subsection (f)(2)(A), such interim report will also serve as the final report for that pilot program. The Secretary shall conduct an evaluation of each model tested, which shall include, at a minimum, an analysis of— the quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary; and the changes in spending by reason of that model. The Secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the Secretary determines is necessary to monitor and evaluate such models. The Secretary shall obtain advice from the Under Secretary for Health and the Special Medical Advisory Group established pursuant to section 7312 of this title in the development and implementation of any pilot program operated under this section. In carrying out the duties under this section, the Secretary shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The Secretary shall use appropriate mechanisms to seek input from interested parties. Taking into account the evaluation under subsection (f), the Secretary may, through rulemaking, expand (including implementation on a nationwide basis) the duration and the scope of a model that is being tested under subsection
(a)to the extent determined appropriate by the Secretary, if— the Secretary determines that such expansion is expected to— reduce spending without reducing the quality of care; or improve the quality of patient care without increasing spending; and the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for applicable individuals. . The table of sections at the beginning of such chapter, as amended by section 122, is further amended by inserting after the item relating to section 1703E the following new item: 1703F. Center for Innovation for Care and Payment. .
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Sec. 402
Authority for Department of Veterans Affairs Center for Innovation for Care and Payment
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