H.R. 740 — Veterans’ ACCESS Act of 2025

This section revises VA access standards for the Veterans Community Care Program (i.e., non-Department care under 38 U.S.C. 1703 when Department facilities cannot meet specified thresholds) by striking the prior requirement for the Secretary to establish such standards and instead codifying eligibility access standards for covered veterans to elect hospital care, medical services, or extended care services (excluding nursing home care). The codified standards provide eligibility if the Department cannot schedule (1) primary care, mental health care, or extended care services (excluding nursing home care) within 30 minutes average driving time from the veteran's residence and 20 days of the request, or (2) specialty care within 60 minutes average driving time and 28 days of the request (or shorter periods as prescribed by the Secretary; longer times or dates if agreed by the veteran and documented in the veteran's electronic health record). (Thus, telehealth availability is excluded from Department compliance determinations; for Department-canceled appointments, wait times are calculated from the original request; and the standards apply to all care in the Department's medical benefits package, excluding nursing home care, for new and established patients alike.) This section further requires the Secretary to review the standards every three years beginning three years after enactment, in consultation with federal agencies (e.g., DOD, HHS, CMS), private-sector entities (e.g., veteran patients, VSOs, community providers), and non-federal entities, and submit findings and recommendations to congressional committees; strikes subsection (g); redesignates remaining subsections; and makes conforming amendments (e.g., updating references to "eligibility access standards," adding headings).

This section requires the Secretary of Veterans Affairs to notify each covered veteran in writing of their eligibility for care or services under the Veterans Community Care Program (i.e., program allowing eligible veterans to obtain care from community providers when VA facilities cannot meet wait-time or drive-time standards) as soon as possible, but not later than two business days, after the Secretary becomes aware that the veteran is seeking and eligible for such care. The section further requires periodic reminders, as determined appropriate by the Secretary, of ongoing eligibility for veterans eligible under subsection (d), which may be provided electronically.

This section directs the Department of Veterans Affairs (VA), under the Veterans Community Care Program (i.e., which furnishes eligible veterans hospital care, medical services, and extended care services from community providers when VA facilities do not meet access standards), to consider in access determinations (1) the covered veteran's preference for where, when, and how to receive such care; (2) continuity of care; and (3) whether the veteran requests or requires a caregiver or attendant for such care.

This section requires the Secretary of Veterans Affairs to notify a veteran in writing, not later than two business days after denial, if a request for care or services under the Veterans Community Care Program (VCCP) is denied, including the reason for the denial and instructions on how to appeal using the Veterans Health Administration clinical appeals process. If the denial is due to not meeting eligibility access standards under section 1703B(a), the notice must explain why the Secretary determined the standards were not met; notifications may be provided electronically.

This section requires the Secretary, when discussing care or services options for covered veterans under the Veterans Community Care Program (i.e., VA program furnishing hospital care, medical services, and extended care services through non-VA providers), to inform the veteran of telehealth options—either through a VA medical facility or under the program—if telehealth is available to the veteran, appropriate for the care or services as determined by the Secretary, and acceptable to the veteran.

This section defines four terms used in this title: (1) covered treatment program, meaning a Department of Veterans Affairs mental health residential rehabilitation treatment program or residential care program for mental health and substance use disorders (including domiciliary residential rehabilitation treatment programs designated as of or after enactment but excluding Compensated Work Therapy Transition Residence programs); (2) covered veteran, meaning a veteran described in 38 U.S.C. §1703(b); (3) social support systems, with respect to a covered veteran, meaning a family member (e.g., parent, spouse, child, step-family member, or extended family member) or non-family cohabitant (excluding facility-organized peer support programs); and (4) treatment track, meaning a specialized treatment program providing the same or similar intensive treatment and rehabilitative services to a subset of covered veterans in a covered treatment program.

This section requires the Secretary of Veterans Affairs, not later than one year after enactment, to establish a standardized screening process to determine, based on clinical need, whether covered veterans qualify for priority or routine admission to covered mental health treatment programs (i.e., residential or inpatient programs for conditions such as substance use disorder or posttraumatic stress disorder). The process must screen veterans within 48 hours of a request (by the veteran or provider); admit those eligible for priority admission within 48 hours of determination; and screen for traumatic brain injury. Priority admission eligibility requires meeting Secretary-established criteria such as symptoms significantly impairing daily activities or increasing adverse outcome risks, unsafe living situations, suicide high-risk flags, overdose risks, or non-response to prior treatments (e.g., outpatient care), with consideration of provider referrals. In placement decisions, the Secretary must consider veteran input on program specialty, treatment track, and location while maximizing proximity to social supports. If unable to provide timely VA-facility admission meeting these requirements, the Secretary must offer care at qualified non-Department (community) providers for (1) priority cases unable to be admitted within 48 hours or (2) routine cases failing access standards under 38 U.S.C. 1703B (i.e., VA community care eligibility standards); such providers must be state-licensed, accredited by the Commission on Accreditation of Rehabilitation Facilities or Joint Commission, and party to (or willing to enter) a VA contract for equivalent programs. (Thus, this standardizes and accelerates access to intensive mental health residential care, prioritizing highest-risk veterans and mandating community care alternatives akin to MISSION Act eligibility.)

This section directs the Secretary of Veterans Affairs to implement improvements to the Department's Mental Health Residential Rehabilitation Treatment Program (RRTP) for covered veterans, including (1) developing performance metrics to track medical facilities' and Veterans Integrated Service Networks' (VISNs) screening and timely admission (routine and priority); (2) creating a quality-of-care oversight process assessing evidence-based treatments, clinical outcomes, practitioner-to-resident ratios, military cultural competence training completion rates, and wasteful practices; (3) providing lists of compliant RRTP locations meeting veterans' care needs and covering transportation costs to and from such programs; (4) establishing a national clinical appeals policy with 72-hour review timelines, public filing guidance tied to access standards under 38 U.S.C. §1703B (for mental health care eligibility), and exclusion from Board of Veterans' Appeals jurisdiction; (5) developing a real-time tracking system for RRTP availability and wait times across Department facilities, VISNs, and non-Department providers, accessible to mental health coordinators, facility and VISN leadership, and the Office of the Under Secretary for Health; and (6) updating staff training on RRTP referrals, screening, admissions, placements, appeals, and care for veterans awaiting admission.

This section directs the Secretary of Veterans Affairs, working with third party administrators (i.e., entities that manage provider networks under the Veterans Community Care Program) through the Center for Innovation for Care and Payment, to develop and implement a plan to establish an interactive, online self-service module. The module (1) allows veterans to request appointments, track referrals for Department or community care, and receive appointment reminders; (2) allows veterans to appeal and track denials of care requests under the Veterans Community Care Program or at Department facilities; and (3) addresses other matters as determined by the Secretary in consultation with third party administrators. This section requires submission of the initial plan to the congressional veterans' affairs committees within 180 days of enactment, as well as quarterly implementation updates for two years thereafter, and clarifies that the module is not a pilot program.

This section modifies the Center for Innovation for Care and Payment within the Department of Veterans Affairs (VA)—which tests payment and service delivery models to reduce expenditures and improve care for veterans—by (1) relocating the Center to the Office of the Secretary (from within the Department); (2) requiring the Secretary to carry out appropriate pilot programs (previously permissive); (3) expanding the purposes of model testing to also increase productivity, efficiency, and modernization throughout VA; (4) requiring a dedicated budgetary line item in VA's annual budget justification to Congress; (5) broadening the Secretary's waiver authority for pilot models to include all provisions of title 38, United States Code, title 38, Code of Federal Regulations, and VA handbooks, directives, or policy documents; (6) limiting concurrent pilot programs to between three and 10 (previously more than 10); and (7) expanding required consultations to additional VA offices (e.g., Office of Integrated Veteran Care, Office of Finance) and entities (e.g., nonprofit organizations). The section also requires (1) annual reports to Congress on the Center's activities, staff, budget, resources, and outcomes; and (2) a Comptroller General report to Congress within 18 months of enactment assessing the Center's fulfillment of its objectives and including recommendations. Additionally, this section directs the Center to establish, within one year of enactment, a three-year pilot program in at least five locations allowing enrolled veterans direct access—without referral or pre-authorization—to outpatient mental health and substance use services from community providers under 38 U.S.C. §1703(c), prioritizing sites based on urbanization levels, veteran suicide/overdose rates, Veterans Crisis Line calls, VA mental health wait times, and value-based care models; requires care coordination elements (e.g., knowledge sharing, transitions of care, personalized plans); mandates metrics for oversight, patient safety, outcomes, and barriers to expansion; and requires annual reports to Congress on the pilot during its duration.

This section directs the Secretary of Veterans Affairs (VA), in consultation with veterans service organizations (VSOs), veterans, caregivers, VA employees, and other stakeholders, to submit to the Senate and House Committees on Veterans' Affairs a report not later than one year after the date of enactment of this Act, and not less frequently than once every three years thereafter, containing recommendations for legislative or administrative actions to improve the VA's clinical appeals process with respect to timeliness, transparency, objectivity, consistency, and fairness. (As background, the clinical appeals process addresses denials of care or services under the community care program established in 38 U.S.C. §1703, which furnishes hospital care, medical services, and extended care services to covered veterans—i.e., those enrolled under 38 U.S.C. §1705 or otherwise eligible—through non-VA providers such as Medicare-participating providers, the Department of Defense, and the Indian Health Service.) This section further directs the Secretary to submit to the same committees a report not later than one year after the date of enactment, and annually thereafter, on the community care program for the preceding one-year period that includes (1) the number of veterans eligible under 38 U.S.C. §1703 and reasons for eligibility; (2) the number of veterans who opt to seek care or services under that section; (3) the number who do not; (4) an assessment of referral timeliness; (5) the number of no-shows for appointments; (6) the number of clinical appeals of denials; (7) the timeliness of each such appeal; and (8) the outcome of each such appeal. This section defines "veterans service organization" as any organization recognized by the Secretary under 38 U.S.C. §5902.