Reform and Update Rural Access to Local Exams Act of 2021 or the RURAL Exams Act of 2021
This bill updates policies and procedures related to covered medical disability examinations provided by the Department of Veterans Affairs (VA) and its contractors. Under the bill, covered medical disability examinations are those that are required for purposes of adjudicating specified VA benefits.
First, the bill requires the VA to begin collecting data to improve veterans' access to covered medical disability examinations.
The VA must study rural veterans' access to covered medical disability examinations and submit a plan to improve access.
Additionally, the VA must ensure that contracts for the provision of covered medical disability examinations by contractors include specified elements. Specifically, such contracts must (1) include financial incentives to encourage timeliness in medical disability examination appointments for rural or housebound veterans, (2) include financial disincentives to encourage timeliness, and (3) require contractors to cooperate with inspections.
Finally, the VA must establish a program of periodic inspections of sites, locations, and facilities where medical disability examinations are provided by VA contractors.
To improve access to medical examinations required by veterans to 
 obtain disability compensation or pension under laws administered by 
       the Secretary of Veterans Affairs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Reform and Update Rural Access to 
Local Exams Act of 2021'' or the ``RURAL Exams Act of 2021''.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Covered medical disability examination.--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.
            (2) Housebound.--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.
            (3) Rural area.--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.
            (4) Rural veteran.--The term ``rural veteran'' means a 
        veteran who resides in a rural area.

SEC. 3. IMPROVING DATA COLLECTION BY DEPARTMENT OF VETERANS AFFAIRS ON 
              COVERED MEDICAL DISABILITY EXAMINATIONS.

    (a) Data Collection Required.--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.
    (b) Elements.--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.
    (c) Disaggregation of Data.--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.
    (d) Publication.--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).

SEC. 4. STUDY ON IMPROVEMENTS TO DEPARTMENT OF VETERANS AFFAIRS COVERED 
              MEDICAL DISABILITY EXAMINATIONS IN RURAL AREAS.

    (a) Study Required.--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.
    (b) Elements.--
            (1) In general.--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.
            (2) National non-rural average defined.--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.
    (c) Report on Study.--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).
    (d) Annual Report on Plans.--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.

SEC. 5. DEPARTMENT OF VETERANS AFFAIRS TIMELINESS REQUIREMENTS FOR 
              PROVISION OF COVERED MEDICAL DISABILITY EXAMINATIONS BY 
              CONTRACTORS TO RURAL AND HOUSEBOUND VETERANS.

    In each contract entered into by the Secretary of Veterans Affairs 
after the date of the enactment of this Act for the provision by a 
contractor of a covered medical disability examination, the Secretary 
shall include the following:
            (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).

SEC. 6. ANNUAL INSPECTIONS BY DEPARTMENT OF VETERANS AFFAIRS OF 
              FACILITIES USED BY CONTRACTORS FOR PROVISION OF COVERED 
              MEDICAL DISABILITY EXAMINATIONS.

    (a) Program Required.--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.
    (b) Number and Periodicity.--
            (1) In general.--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.
            (2) Initial inspections.--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.
    (c) Selection of Sites, Locations, and Facilities for Inspection.--
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.
    (d) Notice and Timing.--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.
    (e) Elements.--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.
    (f) Annual Reports.--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.
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RURAL Exams Act of 2021
A bill to improve access to medical examinations required by veterans to obtain disability compensation or pension under laws administered by the Secretary of Veterans Affairs, and for other purposes.
RURAL Exams Act of 2021
Reform and Update Rural Access to Local Exams Act of 2021
Sen. Tester, Jon