RURAL Exams Act of 2021

The term covered medical disability examination means a medical examination that the Secretary of Veterans Affairs determines necessary for the purposes of adjudicating a benefit under chapter 11 or 15 of title 38, United States Code, regardless of whether conducted by an employee or a contractor of the Department of Veterans Affairs.

The term housebound, with respect to a veteran, means—

(A) the veteran meets the requirement of permanently housebound as described in section 1114(s) of title 38, United States Code;

(B) the veteran meets the requirement of permanently housebound as described in section 1502(c) of such title; or

(C) the Secretary has determined that the veteran faces significant difficulty in traveling to obtain a covered medical disability examination.

The term rural area means any non-urban area, within the meaning of the Rural-Urban Commuting Area Codes system of the Department of Agriculture and the Department of Health and Human Services, or successor system.

The term rural veteran means a veteran who resides in a rural area.

Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall begin collecting data to improve access of veterans to covered medical disability examinations.

Data collected under subsection (a) shall include data regarding the following:

(1) Timeliness, quality, and veteran satisfaction measurements of covered medical disability examinations.

(2) Proportion of completed covered medical disability examinations determined to be inadequate for the adjudication of a claim for compensation or pension under chapter 11 or 15 of title 38, United States Code.

(3) Every performance standard required for eligibility for financial incentives or disincentives in a contract between the Department of Veterans Affairs and any contractor for the provision of a covered medical disability examination.

The Secretary shall disaggregate data collected under subsection (a) by—

(1) State;

(2) county; and

(3) as the case may be—

(A) individual contractor with a Department of Veterans Affairs contract for the provision of a covered medical disability examination; or

(B) individual Veterans Health Administration facility conducting a covered medical disability examination.

Not later than one year after the date of the enactment of this Act, the Secretary shall make publicly available on an internet website, and updated not less frequently than quarterly, all data collected under subsection (a).

Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall complete a study on access by rural veterans to covered medical disability examinations.

The study conducted under subsection (a) shall include the following:

(A) A comparison of the average number of days to complete covered medical disability examinations for rural veterans compared to the national non-rural average time to complete covered medical disability examinations, by either contractors or employees of the Department.

(B) A root cause analysis of differences identified pursuant to subparagraph (A).

(C) The plan of the Secretary for the following year to improve access described in subsection (a), which shall include a plan for the pursuit of a commercial or industry-standard solution or technology that could enable rural or housebound veterans to receive examinations without traveling long distances.

For purposes of paragraph (1)(A), the term national non-rural average means the national average of all periods in the previous calendar year—

(A) beginning on the date on which a contractor received a request from the Secretary to conduct a covered medical disability examination for a veteran who is not a rural veteran; and

(B) ending on the date on which the examination was completed.

Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the findings of the Secretary with respect to the study completed under subsection (a).

Not later than two years after the date of the enactment of this Act and not less frequently than once each year thereafter, the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report evaluating the conduct of the plans of the Secretary to improve access described in subsection (a) and a new or revised plan for such improvement in the following year.

(1) Such financial incentives as the Secretary considers appropriate to encourage a contractor to provide a covered medical disability examination to a rural veteran or a housebound veteran in a timely manner.

(2) Such financial disincentives as the Secretary considers appropriate to discourage a contractor from failing to provide a covered medical disability examination to a rural veteran or a housebound veteran in a timely manner.

(3) A requirement that the contractor cooperate with inspections conducted under the program required by section 6(a).

Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall establish a program of periodic inspections of sites, locations, and facilities where covered medical disability examinations are provided by contractors of the Department of Veterans Affairs.

Under the program required by subsection (a), the Secretary shall, each year, inspect not fewer than three percent of all sites, locations, and facilities used by a contractor of the Department to provide a covered medical disability examination during the previous one-year period.

Paragraph (1) shall apply with respect to the first one-year period beginning after the date of the establishment of the program pursuant to subsection (a) and each year thereafter.

Under the program required by subsection (a), the Secretary shall—

(1) use both random and targeted methods of selecting sites, locations, and facilities for inspection; and

(2) ensure that the number of inspections of sites, locations, and facilities in rural areas bears the same ratio to the total number of inspections as the number of covered medical disability examinations provided by contractors of the Department to rural veterans bears to the total number of covered medical disability examinations provided by contractors of the Department to all veterans.

Each inspection under the program required by subsection (a) shall be conducted during such business hours as the Secretary considers reasonable and the Secretary shall provide no more notice than the Secretary considers necessary to ensure the inspected facility is available for such inspection.

Each inspection conducted under the program required by subsection (a) shall include inspection of a site, location, or facility for the following:

(1) Compliance with the terms of any applicable contract.

(2) Compliance with the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.).

(3) Cleanliness.

(4) General fitness for a covered medical disability examination.

(5) Such other elements as the Secretary considers necessary to ensure that covered medical disability examinations provided on behalf of the Department are safe, clean, accessible, and dignified.

Not later than one year after the date of the establishment of the program required by subsection (a), the Secretary shall submit to the Committee on Veterans' Affairs of the Senate and the Committee on Veterans' Affairs of the House of Representatives a report on the findings of the Secretary with respect to the inspections conducted under the program during the one-year period ending on the date of the submittal of the report.