S. 275 — Veterans’ Assuring Critical Care Expansions to Support Servicemembers (ACCESS) Act of 2025

This section codifies specific eligibility access standards in 38 U.S.C. 1703B for covered veterans to elect non-Department hospital care, medical services, or extended care services (excluding nursing home care) through the Veterans Community Care Program when the Department cannot schedule qualifying VA appointments. (As background, the program—expanded under the VA MISSION Act of 2018—authorizes community care for timely access; previously, the Secretary established such standards, subject to periodic review and congressional reporting.) The standards are (1) for primary care, mental health care, or extended care services (excluding nursing home care), an appointment within 30 minutes average driving time (or shorter, as prescribed) from the veteran's residence and within 20 days (or shorter) of the request, unless a longer time is agreed upon; and (2) for specialty care, within 60 minutes average driving time (or shorter) and 28 days (or shorter) of the request, unless agreed upon. In applying the standards, the Secretary excludes telehealth availability considerations; calculates wait times for canceled VA appointments from the original request date; and must document any agreed extensions in the veteran's electronic health record (providing a copy). The standards apply to all care in the VA medical benefits package (excluding nursing home care) for all covered veterans. This section further requires the Secretary to review the standards not later than three years after enactment of this Act and every three years thereafter (from previous reviews three years after standards' establishment), including consultations with federal entities (e.g., DOD, HHS, CMS), private sector stakeholders (e.g., veteran patients, VSOs, community providers), and nongovernmental entities, and to report findings and recommendations to congressional committees; it also makes conforming amendments, including redesignations and revised terminology from "access standards established under this section" to "eligibility access standards under subsection (a)."

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 as soon as possible, but not later than two business days, after becoming aware 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 requires the Department of Veterans Affairs (VA), under the Veterans Community Care Program, to consider three additional factors when determining access standards for hospital care, medical services, or extended care services: (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 the assistance of a caregiver or attendant. (The Veterans Community Care Program allows eligible veterans to obtain care from community providers when VA facilities cannot meet specified standards for wait times or drive distances.)

This section requires the Secretary of Veterans Affairs to notify a veteran in writing, as soon as possible but not later than two business days after denying a request for care or services under the Veterans Community Care Program (i.e., the program furnishing hospital care, medical services, and extended care services to covered veterans—generally those enrolled under 38 U.S.C. § 1705 or otherwise eligible—through non-Department providers such as Medicare-participating providers), of (1) the reason for the denial and (2) 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 38 U.S.C. § 1703B(a), the notice must explain why those standards were not met. Such notification may be provided electronically.

This section requires the Secretary, when discussing options for care or services for covered veterans under the Veterans Community Care Program (i.e., the program furnishing hospital care, medical services, and extended care services through non-Department providers), to inform the veteran of telehealth options through a Department 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 for purposes of this title: (1) covered treatment program, as a Department of Veterans Affairs (VA) 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, as a veteran described in 38 U.S.C. § 1703(b); (3) social support systems, with respect to a covered veteran, as family members (e.g., parents, spouses, children, step-family members, or extended family members) or non-family cohabitants (excluding facility-organized peer support programs); and (4) treatment track, as 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 the date of 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 substance use disorders, mental health conditions, or co-occurring disorders). Under the process, the Secretary must (1) screen requested veterans within 48 hours and admit those eligible for priority admission within 48 hours of determination; (2) establish priority admission criteria including symptoms significantly affecting daily activities and increasing adverse outcome risks, unsafe living situations, suicide or overdose risks, non-response to prior treatment, and other factors as determined appropriate, while considering provider referrals; (3) screen for traumatic brain injury; and (4) in placements, consider veteran input on program type, treatment track, and location while maximizing proximity to social supports. If the Department cannot provide timely admission at VA facilities—including for routine admissions in compliance with access standards under 38 U.S.C. 1703B—the Secretary must offer care at qualified non-Department facilities that are contracted, state-licensed, and accredited by the Commission on Accreditation of Rehabilitation Facilities or the Joint Commission. (Thus, the provision standardizes and accelerates access to intensive mental health care for at-risk veterans, with community care options as a backstop.)

This section requires the Secretary of Veterans Affairs to improve the Department's Mental Health Residential Rehabilitation Treatment Program by (1) developing metrics to track facility and Veterans Integrated Service Network (VISN) performance on screening for and timely routine or priority admission to the program; (2) establishing a process to assess care quality by Department and non-Department providers, including evidence-based treatments, clinical outcomes, practitioner-to-resident ratios, military cultural competence training completion rates, and wasteful practices; (3) providing admitted veterans lists of compliant locations meeting their care needs and covering transportation costs to and from program facilities; (4) creating a national clinical appeals policy with 72-hour decision timelines for denials or untimely placements, public filing guidance referencing access standards under 38 U.S.C. 1703B, and no Board of Veterans' Appeals review; (5) developing a real-time tracking system for program availability and wait times across Department facilities, VISNs, and non-Department providers, shared with mental health coordinators, facility and VISN leadership, and the Office of the Under Secretary for Health; and (6) updating and requiring staff training on program 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, 38 U.S.C. 1703) and acting 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 health care under laws administered by the Secretary (whether at Department facilities or through non-Department providers), and receive appointment reminders; (2) allows veterans to appeal and track decisions relating to denials of requests for care or services under 38 U.S.C. 1703 (Veterans Community Care Program) or at Department facilities under 38 U.S.C. 1710; and (3) addresses other matters as determined appropriate by the Secretary in consultation with third party administrators. It requires submission of the initial plan within 180 days of enactment to the congressional Veterans' Affairs Committees and quarterly implementation updates for two years thereafter. This section states that the module is not a pilot program under 38 U.S.C. 1703E.

This section modifies requirements for the Center for Innovation for Care and Payment (CICP) within the Department of Veterans Affairs (VA). (As background, the CICP tests payment and service delivery models to reduce VA expenditures while preserving or enhancing care quality, access, timeliness, and patient satisfaction for veterans.) Specifically, it (1) relocates the CICP to the Office of the Secretary (from within the Department); (2) requires the Secretary to carry out appropriate pilot programs (previously permissive); (3) expands the purposes of model testing to include increasing productivity, efficiency, and modernization throughout the VA; (4) requires a dedicated budgetary line item in annual VA budget justifications to Congress; (5) broadens waiver authority for pilot models to include all provisions of title 38, United States Code, title 38 of the Code of Federal Regulations, and VA handbooks, directives, or policy documents; (6) limits the number of concurrent pilot programs to between three and 10 (previously no fewer than three and no more than 10); (7) expands the CICP advisory committee to include additional VA offices (Office of Integrated Veteran Care, Office of Finance, Veteran Experience Office, Office of Enterprise Integration, and Office of Information and Technology) and representatives from nonprofit organizations and other public and private sector entities; and (8) requires annual reports to Congress on the CICP's activities, staff, budget, resources, and outcomes. This section also requires the Comptroller General to submit a report to Congress within 18 months of enactment assessing the CICP's fulfillment of its objectives and including recommendations. Additionally, this section directs the CICP to establish a three-year pilot program, within one year of enactment, in not fewer than five locations allowing VA-enrolled veterans to access outpatient mental health and substance use services through providers under 38 U.S.C. 1703(c) without referral or pre-authorization. Site selection prioritizes areas with varying urbanization (urban, rural, highly rural); high veteran suicide, overdose, or Veterans Crisis Line call rates; long VA mental health wait times; and value-based care models where practicable. The pilot requires a care coordination system for knowledge sharing, care transitions (e.g., inpatient, detoxification, residential services), patient needs assessment, and personalized care plans; metrics for oversight, patient safety, outcomes, and barriers to VA-wide expansion; and annual reports to Congress beginning one year after commencement.

This section directs the Secretary of Veterans Affairs, in consultation with veterans service organizations, veterans, caregivers, Department employees, and other stakeholders, to submit to the Senate and House Committees on Veterans’ Affairs (1) not later than one year after enactment of this Act and not less frequently than every three years thereafter, a report containing recommendations for legislative or administrative action to improve the Department's clinical appeals process with respect to timeliness, transparency, objectivity, consistency, and fairness; and (2) not later than one year after enactment and annually thereafter, a report on the community care program under 38 U.S.C. §1703 (i.e., program furnishing hospital care, medical services, and extended care services to covered veterans through non-Department providers) that includes, for the preceding one-year period, the number of eligible veterans and reasons for eligibility, the number who opt to seek or not seek such care, timeliness of referrals, no-show appointments, and clinical appeals (including number, timeliness, and outcomes). This section defines "veterans service organization" as any organization recognized by the Secretary under 38 U.S.C. §5902.