The document titled the “Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act” is a bill that aims to enhance healthcare, economic opportunities, and support for veterans, as well as improve oversight and address homelessness issues. It includes provisions for veterans' healthcare programs, support for family caregivers, educational assistance, employment and training services, home loans for Native American veterans, disability benefits, and programs for homeless veterans, with an emphasis on accountability and transparency.

The section mandates that the Secretary of Veterans Affairs must allow veterans and their referring clinicians to make final decisions about eligibility for care under the Veterans Community Care Program. It also requires the Secretary to report to Congress on the care provided and permits veterans and clinicians to fix any errors in eligibility determinations.

The section amends U.S. Code to require the Secretary of Veterans Affairs to inform veterans about their options under the Veterans Community Care Program through regular outreach. This includes displaying information in medical facilities and online, with additional reporting by the Comptroller General on the effectiveness of these efforts.

The section requires the Secretary of Veterans Affairs to annually review and report on waivers for payment rates under the Veterans Community Care Program. The report must detail the number of waivers requested and granted, the approval process, and how the waivers impact veterans' access to healthcare, along with any identified trends, with the first report due within 180 days of the act's enactment.

The bill section amends and updates the Department of Veterans Affairs' standards for quality care to ensure they align with industry standards. It requires regular updates, collaboration with various health entities, and the use of advanced data practices. The Secretary of Veterans Affairs must report to Congress on these updates and implement changes from audits conducted by non-government entities, which evaluate the effectiveness and accuracy of the care quality metrics.

The section outlines a pilot program by the Secretary of Veterans Affairs to enhance care under the Veterans Community Care Program. It aims to offer incentives to health care providers to improve appointment scheduling, training, medical record documentation, and reduce no-shows. The program requires annual reports on progress and includes definitions for terms like "covered health care provider" and "opioid safety initiative."

The bill proposes a pilot program where the Department of Veterans Affairs would hire general dentists and dental specialists to streamline the approval process for veterans' dental care plans. The program will run in at least two VA service networks and will be assessed through reports to determine its effectiveness and future implementation.

The bill requires the Secretary of Veterans Affairs to create a working group that will develop a strategic plan to implement value-based healthcare in the Veterans Health Administration. Additionally, the plan's strategies for improving healthcare will be tested through a three-year pilot program in various regions, and the Secretary must report on its progress and outcomes to Congress.

The section outlines a plan for the Department of Veterans Affairs to adopt national health information standards and facilitate electronic health record exchanges with community care providers. It requires reports on the plan's progress, prioritizes access to electronic exchanges for rural providers, and defines key terms like "community care provider."

The section requires the Secretary of Veterans Affairs to provide a report to the Veterans' Affairs Committees in Congress within one year on how value-based reimbursement models are used in the Veterans Community Care Program to ensure quality care for veterans. It also clarifies that the section is not a pilot program and defines the role of third-party administrators who manage provider networks for veterans' care.

The Inspector General is required to evaluate how well the Department of Veterans Affairs is managing the Veterans Community Care Program by checking if they are correctly identifying and informing eligible veterans and providing them with timely services. Additionally, the Inspector General must brief the Veterans Affairs Committees in Congress on these assessments.

The section requires the Comptroller General to report to Congress about dental care for veterans through the Veterans Community Care Program. The report will examine how current reimbursement rates affect dental care availability and provider satisfaction, as well as the processes for approving both regular and emergency dental care.

The bill increases the spending limit for certain types of noninstitutional care for veterans from 65% to 100% of what the cost would be for nursing home care. It also allows for this limit to be exceeded in special cases, such as for veterans with severe conditions like ALS or spinal cord injuries, based on specific needs or circumstances.

The bill requires that if a medical center for veterans is in an area where the PACE program is available, the Secretary must try to make an agreement with the PACE program to provide services to veterans.

The bill allows the Secretary of Veterans Affairs to give grants or contracts to organizations to improve mental health support for family caregivers of veterans. It outlines eligibility criteria, distribution priorities, outcome measures, performance reviews, and funding details, aiming to enhance support services for caregivers nationwide.

The section allows the Secretary of Veterans Affairs to award grants for mental health support to family caregivers of veterans, with priority given to areas with high veteran enrollment in the family caregiver program or high veteran suicide rates. The grants must be equitably distributed across different urbanization levels and are intended to enhance programs or services, meet specific veteran needs, and cannot exceed 10 percent of the available funding for a fiscal year.

The section establishes several programs for veterans' home- and community-based services, including the Veteran-Directed Care program, providing funds for in-home care and services, the Homemaker and Home Health Aide program for home health aide services, and the Home-Based Primary Care and Purchased Skilled Home Care programs. It also outlines caregiver support measures, responsibilities for program administration, and defines key terms, with an implementation deadline of two years after the Act's enactment.

The text explains that the U.S. Secretary of Veterans Affairs will provide programs offering home and community-based services to veterans as alternatives to nursing home care. These include the Veteran-Directed Care program, Homemaker and Home Health Aide program, Home-Based Primary Care program, Purchased Skilled Home Care program, and caregiver support, aiming to enhance veterans' quality of life while keeping them out of institutional care when possible.

The section outlines changes to the way the Department of Veterans Affairs coordinates services for veterans and their family caregivers, including providing options for alternative programs and ensuring a smooth transition when veterans or caregivers are denied or discharged from certain services. It also addresses the standardization of respite care across programs and calls for a review to improve communication with caregivers about available services.

The section amends a law to improve the program that helps family caregivers of veterans by detailing the criteria for eligibility, requiring an annual report with specific data on applications and decisions, and ensuring privacy laws are followed while sharing data.

The section details a three-year pilot program initiated by the Secretary of Veterans Affairs to provide home health aide services to veterans in areas with a shortage of these aides, allowing for the hiring or reassignment of nursing assistants. The Secretary must report the program's results and financial details to Congress and update the program’s guidance to ensure smooth transitions for veterans into other care programs.

The bill establishes a pilot program for assisted living services for eligible veterans, to be carried out by the Secretary of Veterans Affairs within selected Veterans Integrated Service Networks. It aims to determine the effectiveness and satisfaction of these services, with provisions for participant selection, service agreements, facility inspections, care continuity, and regular reporting to the relevant Congressional committees.

The Secretary of Veterans Affairs is allowed to give medicine, protective gear, and other supplies to State homes. The term "personal protective equipment" refers to items like gloves, masks, and gowns that protect against diseases, and a "State home" is defined by a specific section of U.S. law.

The Secretary of Veterans Affairs must create a system to officially recognize organizations and individuals who help veterans, their families, and caregivers navigate the Veterans Health Administration's programs and services, within one year of the act's enactment. This system will involve getting input from relevant organizations and will require that no fees be charged for assistance provided.

The bill section proposes enhancements to the Department of Veterans Affairs' home- and community-based services by reviewing and improving programs, assessing staffing, setting goals for accessible and specialized care, and involving collaboration with other health organizations. It also mandates reports to Congress on the findings and recommendations to address veterans' and caregivers’ needs, with particular attention to rural, Native American, and Native Hawaiian veterans.

The section mandates that within a year, the U.S. Comptroller General must report to Congress on mental health support available to caregivers of veterans. The report should assess caregivers' need for mental health support, options and accessibility of services, awareness, and barriers related to such support in Department of Veterans Affairs facilities and the community.

The Secretary is required to create and maintain a public website for the Department that serves as a hub for information on certain programs. This website must describe each program, include an assessment tool for veterans and their caregivers to check eligibility, and list procedures for assessing veteran participation in these programs, with regular updates to its content.

This section defines various terms related to programs and services of the Department of Veterans Affairs, including caregivers, covered programs, and home- and community-based services, with specific references to sections of the United States Code. It also includes terms like "Vet Center" and "veterans service organization."

The section requires the Secretary of Veterans Affairs to submit a quarterly report to Congress on referrals for health care outside the Department of Veterans Affairs. This report must detail the time taken at each stage of the referral process, from a veteran needing care to the actual appointment with an outside provider.

The section requires the Secretary of the Department of Veterans Affairs to submit quarterly reports to Congress detailing the timelines of referrals for veterans' care sent from Department facilities to non-Department health care providers. These reports must include various time intervals, such as how long it takes for a referral to be made, accepted, completed, and for a follow-up appointment to occur, among others.

The bill changes how certain Department of Veterans Affairs Assistant Under Secretaries are managed. It removes a specific requirement, changes the labeling of subsections, and updates a reference from one subsection to another.

The bill modifies payment rules for physicians, podiatrists, optometrists, and dentists in the Department of Veterans Affairs, including allowing market pay adjustments, providing retroactive compensation for certain past periods, and introducing waivers for pay limits to recruit or retain critical healthcare personnel. It also clarifies roles and compensation grades for optometrists and incorporates them into existing health professional regulations.

The Secretary of Veterans Affairs will pay or reimburse certain rural veterans for ambulance transportation costs up to $46,000, including air ambulance, to the nearest suitable hospital or care provider by September 30, 2026. This applies to veterans with specific service-connected disabilities, who cannot claim travel reimbursements elsewhere, and live far from Veterans Affairs medical centers in rural areas.

The section establishes a two-year pilot program by the Department of Veterans Affairs to provide dental care to certain veterans diagnosed with ischemic heart disease, especially in rural areas. The program will use different methods to deliver care, evaluate dental service networks, and involve regular reporting to Congress on its effectiveness and potential continuation or expansion.

The bill section requires the Secretary of Veterans Affairs to create a system within one year to gather veterans' preferences on how they want to schedule health care appointments. These preferences, such as contact methods and scheduling times, will be documented in a system like My HealtheVet and used by staff involved in appointment scheduling. The mechanism will first be tested in three diverse regions, and improvements will be made based on feedback before it's implemented nationwide.

The section requires the Department of Veterans Affairs to create and implement a staffing model and performance metrics to improve veterans' access to care. The Secretary must report to Congress on the implementation and effectiveness of the staffing model and performance metrics, and the Government Accountability Office will review and provide further recommendations.

The Secretary of Veterans Affairs must create an online health education portal for veterans within one year. This portal will help veterans understand their health care benefits and services, including those available through the Veterans Community Care Program.

The section outlines rules for detailing directors of Department of Veterans Affairs medical centers to other positions within the Department. It mandates timely notifications to Congress, appointing an acting director if needed, frequent updates to Congress about the detail status, and requires the detailed director to either return to their original position or be reassigned within 180 days, unless an extension is granted for specific reasons.

The National Veteran Suicide Prevention Annual Report requires the Department of Veterans Affairs to regularly publish detailed reports on veteran suicide rates, including various demographic data and analyses of veterans' engagement with healthcare and benefits. Additionally, the act mandates independent assessments of these reports and instructs the development of a toolkit for better reporting and prevention of veteran suicides by state and local authorities, with a focus on collaboration and data accuracy.

The section requires the Secretary of Veterans Affairs to prepare and submit a report to Congress within a year of the law's enactment. This report must detail the current and future physical infrastructure needs, like buildings and renovations, for VA medical facilities to provide dental care to eligible veterans, and what changes would be necessary if more veterans became eligible.

The section requires the Comptroller General to submit a report within one year to Congressional committees on the Veterans Affairs Department's oral health care programs. The report should cover various topics like information technology issues, dental insurance plan implementation, program expansions, barriers to care for veterans with heart disease, and demographics of those eligible for care.

The Secretary of Veterans Affairs is required to review how patient referrals between Veterans Health Administration facilities are processed to find and address any delays or issues. This review will look into the guidance on managing referrals and the roles of people involved, with a report on these findings due to Congress within 180 days.

The section requires the Secretary of Veterans Affairs to create a plan ensuring that veterans can schedule appointments at VA medical facilities over the phone during their call and aims to provide timely or same-day scheduling. It also mandates a report to be submitted to Congress about this plan within one year of the Act's enactment, and it defines "covered veteran" as those enrolled in the VA's patient system.

The section authorizes $5 million for the fiscal year 2025 to support the Department of Veterans Affairs in providing mobile mammography services for women veterans. This funding aims to improve access to mammography through mobile initiatives, advanced equipment, and outreach activities.

The bill section temporarily extends the eligibility for the Marine Gunnery Sergeant John David Fry Scholarship to children and spouses of military members who die from a service-connected disability within 120 days after leaving service, provided they were honorably discharged. This change applies to deaths occurring at any time and covers academic terms starting between August 1, 2025, and October 1, 2027.

The section removes the expiry date for the Marine Gunnery Sergeant John David Fry Scholarship, allowing surviving spouses to continue receiving this education benefit without time limitations, and reorganizes the related paragraphs in the law for clarity.

The section modifies the rules about who is responsible for paying back educational assistance if someone doesn't complete the required service agreement. It states that the individual who transfers the benefit is solely responsible for the repayment unless certain conditions are met, in which case neither the individual nor the dependent needs to repay the overpayment.

Section 204 of the bill changes the time frame for notifying educational institutions about risk-based surveys from "one business day" to "two business days."

The amendment to paragraph (4) of section 3675(b) of title 38 allows an educational institution to be approved for Department of Veterans Affairs educational assistance programs if it either participates in a Title IV program under the Higher Education Act of 1965 or, if it does not participate, receives a waiver from the Secretary, demonstrating reasons like electing not to participate or actively working to apply, with the waiver lasting no longer than 36 months.

The bill expands the oversight of the Department of Veterans Affairs on certain educational institutions by requiring them to notify the State approving agency within 30 days if they become involved in specific actions or events, amends existing sections to accommodate this requirement, and sets a deadline of 180 days for the VA to establish a risk-based surveys database.

The section outlines that educational institutions offering programs approved by the Department of Veterans Affairs must provide digital copies of official transcripts to eligible students or veterans. These changes will take effect from August 1, 2025, and apply to academic periods starting on or after that date.

The section changes the law to allow veterans taking their final semester of school to receive a full monthly housing stipend as if they were full-time students, even if they are enrolled in fewer classes. This change will start applying from January 1, 2025.

The bill changes the rules for approving commercial driver education programs under the Department of Veterans Affairs' educational assistance programs. It allows certain driver education programs at educational institution branches to be exempt from prior approval requirements, provided they are licensed and meet specific criteria, like using the same curriculum as approved programs. The Secretary of Veterans Affairs will set reporting rules for these exemptions, consult on their implementation, and must notify Congress of any exemptions granted. Additionally, the Comptroller General will study the impact of these changes and report back to Congress.

The section mandates that the Secretary must provide individuals with certificates of eligibility and award letters for educational assistance through electronic means, unless the individual chooses to receive them by mail instead. It covers certain educational assistance programs, and individuals can change their preference for electronic or mail delivery at any time.

The section requires the Secretary to send certificates of eligibility and award letters for educational benefits through electronic means, unless an individual chooses to receive them by mail. Individuals can switch back to electronic delivery at any time. It applies to assistance under specific educational programs.

The section amends a part of the United States Code to specify that a rule about educational assistance applies to courses or programs that closed or were discontinued between August 1, 2021, and September 30, 2025. This affects students who couldn't transfer credits from these closed or disapproved programs.

The section establishes a high technology educational program for certain veterans, offering training in fields like computer programming and information sciences. The program, which is set to end in 2027, caps participation at 4,000 individuals per year and provides educational assistance covering tuition and fees, with potential bonus payments to providers based on student success in employment or further education.

The section outlines a program administered by the Secretary to help certain veterans enroll in high-tech educational programs that teach skills needed by employers. The program provides financial assistance for tuition and includes conditions for program eligibility, such as instructor expertise and job placement rates, with a set limit on participation and a termination date in 2027.

The bill introduces a rule requiring that any changes the Secretary of the Department of Veterans Affairs makes to policies or guidance on educational assistance programs cannot take effect until 90 days after informing students, educational institutions, and relevant Senate and House Committees about the changes and the reasons for them. Additionally, the bill updates the table of contents for the chapter to include this new section.

The law states that if the Secretary wants to change a policy or guidance related to educational assistance programs, they must inform students, schools, and relevant congressional committees about the change at least 90 days before it is put into effect.

The section requires the Secretary of Veterans Affairs to update their payment system within 90 days to enable sending educational assistance payments directly to foreign colleges that either don't have a U.S. employer ID or a domestic bank account, as long as they provide approved courses to eligible students.

The bill section aims to improve the G.I. Bill Comparison Tool, providing veterans and service members with better information on educational institutions and programs. It requires updates to the tool, collaboration with other federal agencies, improved student feedback mechanisms, and training for Veterans Affairs staff to enhance educational counseling services.

The section outlines improvements to the employment rights of U.S. Armed Forces members, detailing changes such as preventing retaliation by employers, expanding legal protections and penalties for violations, mandating attorney fees for successful claims, and commissioning reviews by the Government Accountability Office (GAO) to ensure proper enforcement and protection under the law.

The Secretary of Labor is required to review and update a specific manual related to veterans' employment and training services every two years for a period of five years. After each review, a report detailing any changes and a copy of the updated manual must be sent to the relevant congressional committees, with any sensitive parts possibly included as a separate addendum.

The section establishes requirements for reporting on the Warrior Training Advancement Course (WARTAC), where the Secretary of Veterans Affairs must submit initial and annual reports about the course, covering topics like participation, best practices, cost savings, and employment of veterans. Additionally, it introduces a pilot program headed by the Secretary of the Interior to employ veterans in conservation-related roles and outlines guidelines, briefings, reporting, and the duration of the program, while encouraging active-duty military to participate in environmental programs.

The section outlines improvements to the program for direct housing loans for Native American veterans, such as ensuring veterans have a meaningful interest in the property, establishing procedures for loan foreclosure and resale, and allowing the Department of Veterans Affairs to provide loans for refinancing existing mortgages. Additionally, it includes measures to expand outreach and assistance programs, assign adequate personnel, and define various terms related to the program.

The bill introduces a program that allows the Secretary to lend money to Native community development financial institutions, which in turn, re-lend these funds to Native American veterans for home-related purposes on trust land. These loans have standards for evaluation, limit the interest to one percent for institutions, and come with oversight to prevent misuse, with the program set to end on September 30, 2027.

The section outlines a relending program where the Secretary can give loans to Native community development financial institutions so they can, in turn, provide loans to Native American veterans for housing on trust land. It establishes standards for these institutions, sets terms for loan use, and includes provisions for oversight and repayment, with a sunset date for new loans on September 30, 2027.

The section allows veterans who die at home while receiving hospice care provided by the Department of Veterans Affairs to qualify for a burial allowance, similar to those who die in a VA hospital or nursing home. This benefit applies to deaths occurring 180 days after the Act's enactment and before October 1, 2026.

The text allows the Secretary of Veterans Affairs to give grants to states and Indian Tribes to help them better inform veterans and their families about benefits they can receive and assist with benefit claims. It specifies the conditions for these grants, prioritizes certain areas such as those with high veteran suicide rates, and requires annual progress tracking and reporting to Congress.

The section provides details about grants given to states and Indian Tribes to improve outreach and assistance for veterans and their families. These funds aim to enhance the submission of benefits claims, increase the number of veterans service officers, and support programs that target underserved communities and areas with high needs, while also tracking and reporting outcomes to ensure effectiveness.

The section updates the definition of "surviving spouse" for most purposes under title 38 of the U.S. Code. It specifies that a surviving spouse is someone who was married to a veteran at their time of death, lived with them continuously (unless any separation was caused by the veteran's wrongdoing), and has not remarried since.

The section ensures that only licensed health care professionals are allowed to perform medical disability examinations in a Department of Veterans Affairs pilot program. It requires the Secretary of Veterans Affairs to enforce this rule, report annually on the pilot program's progress, and make necessary technical updates to the related law.

The text addresses a new rule that requires the Secretary to give contact information of approved agents or attorneys to health care professionals performing medical disability exams for veterans under a specific program. This rule applies to exams conducted from the date the law is enacted.

The bill requires the Department of Veterans Affairs to develop a way for medical data from non-VA providers about disability benefits to be sent in a machine-readable format within 180 days. It also requires the Secretary to update standards for this data, modify information systems for better data collection, and publicly share the information online.

The Department of Veterans Affairs (VA) must update its technology within a year to automate the processing of certain temporary disability claims for veterans, as specified in a specific section of the U.S. Code. While automation will streamline the process, VA employees will still decide if a veteran qualifies for these disability ratings, and claims can be handled manually if the necessary evidence is not compatible with the system.

The section introduces Title 401 of a bill, which is called the “Housing our Military Veterans Effectively Act of 2024” or simply the “HOME Act of 2024.”

The section amends the U.S. Code to adjust per diem payments for services to homeless veterans, allowing temporary increases and waivers on the maximum rate for payments under certain conditions, while setting a cap on the total number of payments. It also requires the Secretary of Veterans Affairs to submit regular reports and a strategic plan to ensure equitable grant distribution considering various factors like costs of living and veterans' needs.

The section allows the Secretary of Veterans Affairs to use government funds until September 30, 2027, to help homeless veterans by providing essentials like food, shelter, and technology for communication, as well as collaborating with organizations to manage land for homeless veterans. The Secretary must report annually to Congress on how the funds are used, including specifics about services provided, the number of veterans helped, and plans for ongoing support.

The new section added to the United States Code requires that, as much as possible, the Secretary of Veterans Affairs must ensure that veterans, case managers, and community service providers have access to telehealth services. This aims to enhance the support for veterans, especially those involved with homeless programs or services funded by the Department.

The Secretary is required to make sure that veterans have access to telehealth services they are eligible for, as much as possible. This includes making sure that telehealth is available to veterans, case managers, and community service providers who work with homeless veterans.

The new law requires that every new employee at the Department of Veterans Affairs gets trained about the Office of Inspector General within their first year. The training covers topics like the role of the Inspector General, how to report problems without fear of punishment, and how employees can work with the office to improve services. The Inspector General will design and update this training and ensure it’s available separately from other training programs, while also using email to remind employees of these responsibilities and resources.

The section mandates that every year for six years, the Department of Veterans Affairs must survey its facilities to assess security issues, including criminal activity, staffing levels, equipment adequacy, and relationships with other law enforcement agencies. It requires the Secretary to report the findings and analysis to Congress and define how they plan to improve security and address any weaknesses.

The section changes the end date for certain housing loan fees in the United States Code from "November 29, 2031" to "June 9, 2034".