S. 2397, CARING for Our Veterans Health Act of 2026

Bill Summary

S. 2397 would require the Department of Veterans Affairs (VA) to include provisions in contracts with health care providers who participate in the Veterans Community Care Program regarding the timely submission of medical records to the department. The bill also would direct VA to communicate the submission requirements to community care providers and offer training on satisfying those requirements. Finally, the bill would require VA to submit annual reports to the Congress for five years on its implementation of the bill’s requirements.

Estimated Federal Cost

The estimated budgetary effects of S. 2397 are shown in Table 1. The costs of the legislation fall within budget function 700 (veterans benefits and services).

Basis of Estimate

For this estimate, CBO assumes that S. 2397 will be enacted in fiscal year 2026 and that outlays will follow historical spending patterns for affected programs.

Provisions That Affect Direct Spending and Spending Subject to Appropriation

S. 2397 would require VA to include provisions in contracts with community care providers regarding the timely submission of veterans’ medical records. Through the Veterans Community Care program, VA pays for veterans to receive health care from providers in their communities, outside of VA facilities, when the department cannot provide such care according to certain standards for availability, timeliness, and quality. The bill also would require the department to communicate the submission requirements to providers and offer training on satisfying those requirements.

According to VA, the department currently receives medical records from community care providers and is working to improve the timeliness and completeness of those submissions. However, implementing the bill’s requirements to standardize submission practices, communicate with providers, and offer training would increase VA’s workload by the equivalent of three full‑time employees, CBO estimates. Annual compensation, benefits, and operating expenses would average about $170,000 per employee. CBO estimates that, in total, implementing those requirements would cost about $6 million over the 2026-2036 period.

VA uses several appropriation accounts to pay for the costs of health care, disability claims processing, medical research, and information technology modernization. One of those accounts, the Toxic Exposures Fund (TEF), is a mandatory appropriation that can be used to pay for some of the costs of those activities if they support veterans who were exposed to toxic substances or environmental hazards.^[1] The other accounts are discretionary appropriations. S. 2397 would affect health care that benefits veterans with and without toxic exposures; therefore, enacting the bill would increase direct spending from the TEF as well as spending subject to appropriation. CBO allocates the estimated costs of legislation between the TEF and the discretionary appropriation accounts on the basis of the portion of all funding for those activities that are projected, in CBO’s baseline, to come from the TEF.

On that basis, CBO estimates that over the 2026-2036 period, implementing the communication and training requirements of S. 2397 would increase direct spending by $2 million and spending subject to appropriation by $4 million.

Spending Subject to Appropriation

In addition to requiring VA to communicate with providers and offer training on the timely submission of medical records, S. 2397 would require the department to submit annual reports to the Congress for five years on its implementation of the bill’s requirements. Based on the costs of similar reporting requirements, CBO estimates that preparing those reports would cost less than $500,000.

In total, CBO estimates that implementing S. 2397 would increase spending subject to appropriation by $4 million over the 2026-2036 period.

Pay-As-You-Go Considerations

The Statutory Pay-As-You-Go Act of 2010 establishes budget-reporting and enforcement procedures for legislation affecting direct spending or revenues. The net changes in outlays that are subject to those pay-as-you-go procedures are shown in Table 2.

Increase in Long-Term Net Direct Spending and Deficits

CBO estimates that enacting S. 2397 would not increase net direct spending by more than $2.5 billion in any of the four consecutive 10-year periods beginning in 2037.

CBO estimates that enacting S. 2397 would not increase on‑budget deficits by more than $5 billion in any of the four consecutive 10-year periods beginning in 2037.

Mandates

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act.

Estimate Prepared By

Federal Costs: Noah Callahan

Mandates: Brandon Lever

Estimate Reviewed By

David Newman
Chief, Defense, International Affairs, and Veterans’ Affairs Cost Estimates Unit

Kathleen FitzGerald 
Chief, Public and Private Mandates Unit

Chad Chirico
Director of Budget Analysis

Estimate Approved By