选择法案

关于2014年《退伍军人准入、选择和责任法案》

The Department of Veterans Affairs (VA) was established to fulfill 总统 Lincoln’s promise “To care for him who shall have borne the battle, and for his widow, and his orphan,” by serving and honoring the men and women who are America’s Veterans.

VA’s goal continues to be to provide timely, high-quality health care for Veterans. VA applauds the passage of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146) (“选择法案”), as amended by the Department of Veterans Affairs Expiring Authorities Act of 2014 (Public Law 113-175), as a bipartisan response to the health care access issues facing VA.

《选择法案》提供了新的权力、资金和其他工具来帮助支持和改革退伍军人管理局。下面的摘要是对《选择法案》的概述，并不意味着对立法的详尽审查。

改善从非退伍军人服务提供者获得护理的机会

退伍军人选择计划 – As directed by the 选择法案, VA will administer the “Veterans Choice Fund” to implement the 退伍军人选择计划 (“the Program”). 该方案将运作3年或直到基金用完为止。 该计划将为2014年8月1日登记的退伍军人或有资格登记为最近退伍的退伍军人提供退伍军人选择卡，并允许那些无法在其首选日期或临床适当日期30天内安排预约的退伍军人，或根据其居住地选择接受符合条件的非va医疗保健实体或提供者的护理。 This is separate from VA’s existing program providing Veterans care outside of the VA system. Eligible non-VA entities or providers must enter into agreements with VA to furnish care, must maintain the same or similar credentials and licenses as VA providers, and must submit to VA a copy of any medical records related to care and services provided under the Program for inclusion in the Veteran’s VA electronic medical record.

处理申索- 退伍军人事务部将建立并实施一个系统，处理和支付非退伍军人事务部提供者根据该计划和其他非退伍军人事务部护理当局向退伍军人提供的护理的索赔。

就近获得项目准入（ARCH） – Project ARCH, is an existing pilot program intended to improve access for eligible Veterans by connecting them to health care services closer to home. 参加试点方案的资格取决于具体标准，包括距离VHA初级保健、急性病医院护理或三级保健保健设施的驾车距离。 试点在5个专项退伍军人综合服务网开展。 《选择法案》将这一试点延长了大约2年。

加强合作 – VA will work with the Indian Health Service (IHS) to ensure that certain medical facilities operated by an Indian tribe or tribal organization are aware of the opportunity to negotiate reimbursement agreements with VA.

– VA will enter into contracts or agreements with certain Native Hawaiian Health Care Systems for reimbursement of direct care services provided to eligible Veterans.

进一步扩大获得医疗服务的机会

延长辅助生活飞行员 – Pursuant to the 选择法案, VA will extend the Assisted Living Pilot Program for Veterans with Traumatic Brain Injury for 3 years, through October 6, 2017. This program assesses the effectiveness of providing assisted living services to eligible Veterans with traumatic brain injuries to “enhance the rehabilitation, quality of life, and community integration of such Veterans.”

流动兽医中心和流动医疗中心 – VA will improve access to telemedicine and other health care services through standardization and greater use of mobile vet centers and mobile medical centers.

审查和扩大产能和流程

独立的评估 – To ensure high-quality care, VA will enter into one or more contracts with an independent third party or parties for assessments of the hospital care, medical services, and other health care processes in VA medical facilities. 评估结果将提交给国会，新成立的医疗委员会，并在网上公布。

科技专责小组 – A 科技专责小组 will review VA’s patient scheduling processes and supporting software, and will do so at no cost to the government. 工作组将提出VA可能采取的具体行动，以改善我们在这一领域的表现，并将他们的建议提交给部长和国会。 退伍军人事务部将执行部长认为可行、明智和具有成本效益的工作组的建议。

主要设施租赁 – The 选择法案 authorizes 27 major medical facility leases in 18 states and Puerto Rico.

公开数据 – Each VA medical facility will post on a Web site the wait-times for scheduling an appointment at VA facilities for primary care, specialty care, and hospital care and medical services based on the general severity of the condition of the Veteran. 每当安排此类约会的等待时间发生变化时，VA将发布修改后的等待时间。

– VA will develop a comprehensive data set that will be made accessible to the public. 该数据集将包括适用于VA医疗保健的患者安全、护理质量和结果措施。

– VA will ensure that Veterans have increased access to information about their doctors. The “Our Doctors” web site will be updated and made more accessible on www.va.gov. 此外，通过退伍军人事务部接受外科手术的每个退伍军人都将获得执行该手术的外科医生证书的信息。

总统保健委员会 – An independent Commission on Care (“the Commission”) will be established to undertake a comprehensive evaluation and assessment of access to health care at VA. The Commission will be made up of 15 voting members selected by Congress and the 总统 and will submit a report of their findings and recommendations to the Secretary and the 总统. 退伍军人事务部和其他联邦机构将被要求执行总统认为可行、明智且无需进一步立法就能实施的每项建议。

卫生保健人员

新的住院医师职位 – Over a five-year period, the legislation directs the VA to increase its number of Graduate Medical Education residency positions by up to 1,500. An emphasis will be placed on creating residency positions that improve Veterans’ access to primary care, mental health, and other specialties the Secretary deems appropriate.

VHA人员配置要求 – The VA Office of Inspector General will identify annually the top five occupations with the largest staffing shortages. 初步报告将于2015年2月3日前提供，年度报告将不迟于每年9月30日提供。 部长将有权招聘和直接任命合格人员担任这些特定职业。

– VA is directed to implement a clinic management training program for two years, with continuously updated materials, to provide in-person, standardized education on health care management to appropriate VA employees.

员工绩效计划 – VA will ensure that scheduling and wait-time metrics or goals are not included as factors in employee performance evaluations or when calculating whether to pay performance awards.

与性创伤有关的保健

军人性创伤 – A Veteran can now receive counseling and appropriate care and services required to overcome psychological trauma resulting from military sexual trauma (MST) that occurred while the Veteran was serving on inactive duty training (such as drill weekends for members of the Reserves and National Guard). 这些福利是免费提供给退伍军人的。

– The 选择法案 also authorizes VA, in consultation with the Department of Defense (DoD), to provide MST-related care and services to members of the Armed Forces on active duty (including members of the National Guard and Reserves) without the need for a referral from a TRICARE provider or a military treatment facility. VA正在与国防部合作实施这一福利。

– The 选择法案 requires VA to produce two reports for Congress on MST-related care and services. 一份报告将比较经历过MST的男性和女性退伍军人的治疗和服务。 另一份报告由VA和DoD共同撰写，将描述从军队到VA经历过MST的个人的医疗保健过渡过程。该报告还将描述VA和DoD在帮助退伍军人提交与MST相关的残疾索赔方面所做的努力。

退伍军人福利

VBA计划/项目需求 – VA will expand the Marine Gunnery Sergeant John David Fry Scholarship to include the spouses of service members who died in the line of duty.

– 项目 of education at public colleges and universities may not be approved for Post-9/11 GI Bill and Montgomery GI Bill (MGIB) benefits if they do not charge all recently released Veterans and their family members in-state tuition and fees.

– The 选择法案 directs VA to extend the reduction in the amount of pension provided by VA for Veterans covered by Medicaid living in nursing facilities until September 30, 2024. 退伍军人事务部还决定将征收住房贷款资金费的规定延长到这一天。

部门人事权力及相关程序

员工纪律处分程序 – VA will revise human resources policies to include penalties for employees who knowingly falsify or require another employee to falsify data regarding access to care or quality measures.

员工奖励和奖金 – VA will limit the amount of awards and bonuses paid to VA employees each year for fiscal year 2015 to fiscal year 2024.