The VISN Reform Act of 2025 aims to significantly restructure and improve the administration of Veterans Integrated Service Networks (VISNs) within the Department of Veterans Affairs. It mandates the reorganization of the Veterans Health Administration into eight geographically defined VISNs, consolidating existing networks to enhance efficiency and alignment with veteran healthcare needs. The Secretary of Veterans Affairs is directed to ensure that each VISN's employees, services, and programs are aligned with the Department's mission and the specific healthcare requirements of its veteran population.

The bill requires the Secretary to maintain a regional integrated healthcare system within each VISN's geographic area. This involves entering into agreements with other healthcare organizations, managing a balanced regional budget, and using national metrics to deliver effective and patient-satisfactory care. A key provision focuses on reducing duplicate functions across clinical, administrative, and operational processes within the Veterans Health Administration.

Furthermore, the legislation establishes strict guidelines for VISN headquarters. Each VISN will have only one headquarters office, co-located with a Department medical center, and limited to not more than 50 full-time employees, with a maximum of 10 contractor employees. The Secretary must develop a comprehensive plan within 180 days to right-size the workforce to meet these limits within three years, ensuring no reduction in veteran access to care. Licensed healthcare professionals affected by these changes are to be offered opportunities to transfer to direct patient care roles.

The bill also reforms VISN leadership by requiring that each VISN Director be appointed by the President with Senate advice and consent, serving as a noncareer appointee. These Directors will be responsible for all VISN functions and for enforcing Department policies among personnel. All VHA employees within a VISN will report directly to the Director, and licensed healthcare employees must work at least one day per week in a Department medical center. Finally, the Secretary is required to conduct a triennial review and assessment of VISN structures and operations, reporting findings and recommendations to Congress.