Sec. 106. Improvements to Department of Veterans Affairs Mental Health Residential Rehabilitation Treatment Program

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The Secretary shall develop metrics to track, and shall subsequently track, the performance of medical facilities and Veterans Integrated Service Networks of the Department in meeting the requirements for— screening, under section 105 of this Act, for the Mental Health Residential Rehabilitation Treatment Program (in this section referred to as the Program ) ; and timely admission, under such screening, to the Program. The metrics developed under paragraph

(1)shall include metrics for tracking the performance of such medical facilities and Veterans Integrated Service Networks with respect to routine and priority admission under the Program. If the Secretary determines that a covered veteran is in need of residential care under the Program, the Secretary shall provide to the covered veteran a list of locations at which such covered veteran can receive such residential care that meets— the standards for screening under section 105 of this Act; and the care needs of the covered veteran, including applicable treatment tracks. The Secretary shall provide transportation or pay for or reimburse the costs of transportation for any covered veteran who is admitted into the Program and needs transportation assistance— from the residence of the covered veteran or a facility of the Department or authorized non-Department facility that does not provide such care to another such facility that provides residential care covered under the Program; and back to the residence of the covered veteran after the conclusion of the Program, if applicable. In making placement decisions under the Program, the Secretary shall consider the input of the covered veteran and the treating clinicians of the covered veteran, including with respect to program specialty, subtype, or treatment track offered to the covered veteran, and the geographic placement of the covered veteran, including family- or occupation-related preferences or circumstances. The Secretary shall develop a national policy and associated procedures under which a covered veteran, a representative of a covered veteran, or a provider who requests a covered veteran be admitted to the Program, including a provider of the Department or a non-Department provider, may file a clinical appeal pursuant to this subsection if the covered veteran is— denied admission into the Program; or accepted into the Program but is not offered bed placement in a timely manner. The national policy and procedures developed under paragraph

(1)for appeals described in such paragraph shall include timeliness standards for the Department to review and make a decision on such an appeal. The Secretary shall review and respond to any appeal under paragraph

(1)not later than 72 hours after the Secretary receives such appeal. The Secretary shall develop, and make available to the public, guidance on how a covered veteran, a representative of the covered veteran, or a provider of the covered veteran can file a clinical appeal pursuant to this subsection— if the covered veteran is denied admission into the Program; if the first date on which the covered veteran may enter the Program does not comply with the standards established by the Department under section 1703B of title 38, United States Code for purposes of determining eligibility for mental health care under subsections

(d)and

(h)of section 1703 of such title; or with respect to such other factors as the Secretary may specify. Nothing in this subsection may be construed as granting a covered covered veteran the right to appeal a decision of the Secretary with respect to admission to the Program to the Board of Veterans’ Appeals under chapter 71 of title 38, United States Code. The Secretary shall, to the extent practicable, create a method for tracking availability and wait times under the Program across all facilities of the Department, Veterans Integrated Service Networks of the Department, and non-Department providers throughout the United States. The Secretary shall, to the extent practicable, make the information tracked under paragraph

(1)available in real time to— the mental health treatment coordinators at each facility of the Department; the leadership of each medical center of the Department; the leadership of each Veterans Integrated Service Network; and the Office of the Under Secretary for Health of the Department. The Secretary shall update and implement training for staff of the Department directly involved in the Program regarding referrals, screening, admission, placement decisions, and appeals for the Program, including all changes to processes and guidance under the Program required by this section and under section 105 of this Act. The training under subparagraph

(A)shall include procedures for the care of covered veterans awaiting admission into the Program and communication with such covered veterans and the providers of such covered veterans. The Secretary shall require the training under subparagraph

(A)to be completed by staff required to complete such training— not later than 60 days after beginning employment at the Department in a position that includes work directly involving the Program; and not less frequently than annually. The Secretary shall track completion of training required under clause

(i)by staff required to complete such training. The Secretary shall review and revise oversight standards for the leadership of the Veterans Integrated Service Networks and the Veterans Health Administration to ensure that facilities and staff of the Department are adhering to the policy of the Program on access to care. The Secretary shall ensure each covered veteran who is screened for admission to the Program is offered, and provided if agreed upon, care options during the period between screening of the covered veteran and admission of the covered veteran to the Program to ensure the covered veteran does not experience any lapse in care. For a covered veteran being treated for substance use disorder, the Secretary shall— ensure there is a care plan in place during the period between any detoxification services or inpatient care received by the covered veteran and admission of the covered veteran to the Program; and communicate that care plan to the covered veteran, the primary care provider of the covered veteran, and the facility of the Program where the covered veteran is or will be residing. The Secretary, in consultation with the covered veteran and the treating providers of the covered veteran in the Program, shall ensure the completion of a care plan prior to the covered veteran being discharged from the Program. The care plan required under subparagraph

(A)for a covered veteran shall include details on the course of treatment for the covered veteran following completion of treatment under the Program, including any necessary follow-up care. The care plan required under subparagraph

(A)shall be shared with the covered veteran, the primary care provider of the covered veteran, and any other providers with which the covered veteran consents to sharing the plan. Upon discharge of a covered veteran under the Program from a non-Department facility, the facility shall share with the Department all care records maintained by the facility with respect to the covered veteran and shall work in consultation with the Department on the care plan of the covered veteran required under subparagraph (A). Not later than two years after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on modifications made to the guidance, operation, and oversight of the Program to fulfill the requirements of this section. The report required by subparagraph

(A)shall include— an assessment of whether costs of the Program, including for residential care provided through facilities of the Department and non-Department facilities, serve as a disincentive to placement in the Program; a description of actions taken by the Department to address the findings and recommendations by the Secretary contained in the report under section 503(c) of the STRONG Veterans Act of 2022 (division V of Public Law 117–328 ), including such actions with respect to— any new locations of the Program added; any beds added at existing facilities of the Program; and any additional treatment tracks or sex-specific programs created or added at facilities of the Department; and such recommendations as the Secretary may have for legislative or administrative action to address any funding constraints or disincentives for use of the Program. Not later than one year after the submission of the report under paragraph (1)(A), and not less frequently than annually thereafter during the duration of the Program, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the operation of the Program. Subject to subparagraph (C), each report required by subparagraph

(A)shall include the following: The number of covered veterans served by the Program, disaggregated by— Veterans Integrated Service Network in which the covered veteran receives care; facility, including facilities of the Department and non-Department facilities, at which the covered veteran receives care; type of residential rehabilitation treatment care received by the covered veteran under the Program; sex of the covered veteran; and race or ethnicity of the covered veteran. Wait times under the Program for the most recent year data is available, disaggregated by— treatment track or specificity of residential rehabilitation treatment care sought by the covered veteran; sex of the covered veteran; State or territory in which the covered veteran is located; Veterans Integrated Service Network in which the covered veteran is located; and facility of the Department at which the covered veteran seeks care. A list of all locations of the Program and number of bed spaces at each such location, disaggregated by residential rehabilitation treatment care or treatment track provided under the Program at such location. A list of any new Program locations added or removed and any bed spaces added or removed during the one-year period preceding the date of the report. Average cost of a stay under the Program, including total stay average and daily average, at— a facility of the Department; and a non-Department facility. A review of staffing needs and gaps with respect to the Program. Any recommendations for changes to the operation of the Program, including any policy changes, guidance changes, training changes, or other changes. The Secretary shall provide the data under this paragraph pursuant to Federal laws and in a manner that is wholly consistent with applicable Federal privacy and confidentiality laws, including the Privacy Act ( 5 U.S.C. 552a ), the Health Insurance Portability and Accountability Act ( Public Law 104–191 ; 42 U.S.C. 201 note) and regulations (title 45, Code of Federal Regulations, parts 160 and 164, or successor regulations), and sections 5701, 5705, and 7332 of title 38, United States Code, to ensure that the provided data, or some portion of the data, will not undermine the anonymity of a veteran. The Secretary shall update the guidance of the Department of Veterans Affairs on the operation of the Mental Health Residential Rehabilitation Treatment Program to reflect each of the requirements under subsections

(b)through (h). The Secretary of Veterans Affairs shall carry out each requirement under this section by not later than one year after the date of the enactment of this Act, unless otherwise specified. Not later than two years after the date of the enactment of this Act, the Comptroller General of the United States shall review access to care under the Program for covered veterans in need of residential mental health care and substance use disorder care. The review required by paragraph

(1)shall include the following: A review of wait times under the Program, disaggregated by— treatment track or specificity of residential rehabilitation treatment care needed; sex of the covered veteran; home State of the covered veteran; home Veterans Integrated Service Network of the covered veteran; and wait times for— facilities of the Department; and non-Department facilities. A review of policy and training of the Department on screening, admission, and placement under the Program. A review of the rights of covered veterans and providers to appeal admission decisions under the Program and how the Department adjudicates appeals. When determining the facility at which a covered veteran admitted to the Program will be placed in the Program, a review of how the input of the covered veteran is taken into consideration with respect to— program specialty, subtype, or treatment track offered to the covered veteran; and the geographic placement of the covered veteran, including family- or occupation-related preferences or circumstances. A review of staffing and staffing needs and gaps of the Program, including with respect to— mental health providers and coordinators at the facility level; staff of Program facilities; staff of Veterans Integrated Service Networks; and overall administration of the Program at the national level. Recommendations for improvement of access by covered veterans to care under the Program, including with respect to— any new sites or types of programs needed or in development; changes in training or policy; changes in communications with covered veterans; and oversight of the Program by the Department. In this section: The term covered veteran means a veteran described in section 1703(b) of title 38, United States Code. The term Mental Health Residential Rehabilitation Treatment Program — means— a mental health residential rehabilitation treatment program of the Department under sections 103 and 104 of the Veterans Mental Health and Other Care Improvement Act of 2008 ( Public Law 110–387 ); and the array of programs and services of the Department that comprise residential care for mental health and substance use disorders; includes— the programs designated as of the date of the enactment of this Act as domiciliary residential rehabilitation treatment programs; and any programs designated as domiciliary residential rehabilitation treatment programs on or after such date of enactment; and does not include compensated work therapy transition resident programs of the Department. The term treatment track means a specialized treatment program that is provided to a subset of covered veterans in the Program who receive the same or similar intensive treatment and rehabilitative services. This section shall terminate on the day that is two years after that date on which the Secretary completes carrying out each requirement pursuant to subsection (j).

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