[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4591 Introduced in House (IH)]
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114th CONGRESS
2d Session
H. R. 4591
To amend title 38, United States Code, to authorize the Secretary of
Veterans Affairs to enter into agreements with certain health care
providers to furnish hospital care, medical services, and extended care
to veterans.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 23, 2016
Mr. Miller of Florida introduced the following bill; which was referred
to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to authorize the Secretary of
Veterans Affairs to enter into agreements with certain health care
providers to furnish hospital care, medical services, and extended care
to veterans.
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 ``Department of Veterans Affairs
Purchased Health Care Streamlining and Modernization Act''.
SEC. 2. AGREEMENTS.
(a) In General.--Subchapter I of chapter 17 of title 38, United
States Code, is amended by inserting after section 1703 the following
new section:
``Sec. 1703A. Veterans Care Agreements with certain health care
providers
``(a) Veterans Care Agreements.--(1) In addition to furnishing
hospital care, medical services, or extended care under this chapter at
facilities of the Department or under contracts or sharing agreements
entered into pursuant to provisions of law other than this section, the
Secretary may furnish such care and services to eligible veterans
through the use of agreements entered into under this section by the
Secretary with eligible providers.
``(2) The Secretary may enter into Veterans Care Agreements under
this section with eligible providers to furnish hospital care, medical
services, and extended care to veterans whom the Secretary determines
that furnishing such care and services at facilities of the Department
or under contracts or sharing agreements under provisions of law other
than this section is impracticable or inadvisable because of the
medical condition of the veteran, the travel involved, or the nature of
the care or services required, or a combination of such factors.
``(b) Veteran Eligibility.--Eligibility of a veteran for care and
services under this section shall be determined as if such care or
services were furnished in a facility of the Department, and provisions
of this title applicable to veterans receiving such care and services
in a facility of the Department shall apply to veterans receiving care
and services under this section.
``(c) Provider Eligibility.--Subject to the certification process
pursuant to subsection (d)(1), a provider of hospital care, medical
services, or extended care is eligible to enter into a Veterans Care
Agreement under this section if the Secretary determines that the
provider meets each of the following criteria:
``(1) The gross annual revenue of the provider in the year
preceding the year in which the provider enters into the
Veterans Care Agreement does not exceed $11,000,000 (as
adjusted in a manner similar to amounts adjusted pursuant to
section 5312 of this title).
``(2) The provider does not otherwise provide such care or
services to patients pursuant to a contract entered into with a
department or agency of the Federal Government.
``(3) The provider is--
``(A) a provider of services that has enrolled and
entered into a provider agreement under section 1866(a)
of the Social Security Act (42 U.S.C. 1395cc(a));
``(B) a physician or supplier that has enrolled and
entered into a participation agreement under section
1842(h) of such Act (42 U.S.C. 1395u(h));
``(C) a provider of items and services receiving
payment under a State plan under title XIX of such Act
(42 U.S.C. 1396 et seq.) or a waiver of such a plan;
``(D) an Aging and Disability Resource Center, an
area agency on aging, or a State agency (as defined in
section 102 of the Older Americans Act of 1965 (42
U.S.C. 3002)); or
``(E) a center for independent living (as defined
in section 702 of the Rehabilitation Act of 1973 (29
U.S.C. 796a)).
``(4) Any additional criteria determined appropriate by the
Secretary.
``(d) Provider Certification.--(1) The Secretary shall establish a
process for the certification of eligible providers to enter into
Veterans Care Agreements under this section that shall, at a minimum,
set forth the following:
``(A) Procedures for the submission of applications for
certification and deadlines for actions taken by the Secretary
with respect to such applications.
``(B) Standards and procedures for the approval and denial
of certifications and the revocation of certifications.
``(C) Procedures for assessing eligible providers based on
the risk of fraud, waste, and abuse of such providers similar
to the level of screening under section 1866(j)(2)(B) of the
Social Security Act (42 U.S.C. 1395(j)(2)(B)) and the standards
set forth under section 9.104 of title 48, Code of Federal
Regulations, or any successor regulation.
``(D) Requirement for denial or revocation of certification
if the Secretary determines that the otherwise eligible
provider is--
``(i) excluded from participation in a Federal
health care program (as defined in section 1128B(f) of
the Social Security Act (42 U.S.C. 1320a-7b(f))) under
section 1128 or 1128A of the Social Security Act (42
U.S.C. 1320a-7 and 1320a-7a); or
``(ii) identified as an excluded source on the list
maintained in the System for Award Management, or any
successor system.
``(E) Procedures by which a provider whose certification is
denied or revoked under the procedures established under this
subsection will be identified as an excluded source on the list
maintained in the System for Award Management, or successor
system, if the Secretary determines that such exclusion is
appropriate.
``(2) To the extent practicable, the Secretary shall establish the
procedures under paragraph (1) in a manner that takes into account any
certification process administered by another department or agency of
the Federal Government that an eligible provider has completed by
reason of being a provider described in any of subparagraphs (A)
through (E) of subsection (c)(3).
``(e) Terms of Agreements.--The Secretary shall ensure that each
Veterans Care Agreement include provisions requiring the eligible
provider to do the following:
``(1) To accept payment for care and services furnished
under this section at rates established by the Secretary for
purposes of this section, which shall be, to the extent
practicable--
``(A) the rates paid by the United States for such
care to providers of services and suppliers under the
Medicare program under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.);
``(B) the rates paid by the United States pursuant
to the Alaska Fee Schedule of the Department of
Veterans Affairs;
``(C) the rates paid by the United States pursuant
to an All-Payer Model Agreement under the Social
Security Act; or
``(D) the rates paid by the United States in a
highly rural area pursuant to section
101(d)(2)(B)(ii)(I) of the Veterans Access, Choice, and
Accountability Act of 2014 (38 U.S.C. 1701 note).
``(2) To accept payment under paragraph (1) as payment in
full for care and services furnished under this section and to
not seek any payment for such care and services from the
recipient of such care.
``(3) To furnish under this section only the care and
services authorized by the Department under this section unless
the eligible provider receives prior written consent from the
Department to furnish care and services outside the scope of
such authorization.
``(4) To bill the Department for care and services
furnished under this section in accordance with a methodology
established by the Secretary for purposes of this section.
``(5) Not to seek to recover or collect from a health-plan
contract or third party (as those terms are defined in section
1729 of this title) for any care or services for which payment
is made by the Department under this section.
``(6) To provide medical records for veterans furnished
care and services under this section to the Department in a
timeframe and format specified by the Secretary for purposes of
this section, except the Secretary may not require that any
payment by the Secretary to the eligible provider be contingent
on such provision of medical records.
``(7) To meet other such terms and conditions, including
quality of care assurance standards, as the Secretary may
specify for purposes of this section.
``(f) Exclusion of Certain Federal Contracting Provisions.--(1)
Notwithstanding any other provision of law, the Secretary may enter
into a Veterans Care Agreement using procedures other than competitive
procedures.
``(2)(A) Except as provided in subparagraph (B) and unless
otherwise provided in this section, an eligible provider that enters
into a Veterans Care Agreement under this section is not subject to, in
the carrying out of the agreement, any provision of law that providers
of services and suppliers under the original Medicare fee-for-service
program under parts A and B of title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.) or the Medicaid program under title XIX of
such Act (42 U.S.C. 1396 et seq.) are not subject to.
``(B) In addition to the provisions of laws covered by subparagraph
(A), an eligible provider shall be subject to the following provisions
of law:
``(i) Any applicable law regarding integrity, ethics, or
fraud, or that subject a person to civil or criminal penalties.
``(ii) Section 431 of title 18.
``(iii) Section 1352 of title 31, except for the filing
requirements under subsection (b) of such section.
``(iv) Section 4705 or 4712 of title 41, and any other
applicable law regarding the protection of whistleblowers.
``(v) Section 4706(d) of title 41.
``(vi) Title VII of the Civil Rights Act of 1964 (42 U.S.C.
2000e et seq.) to the same extent as such title applies with
respect to the eligible provider in providing care or services
through an agreement or arrangement other than under a Veterans
Care Agreement.
``(C) An eligible provider that receives a payment from the Federal
Government pursuant to a Veterans Care Agreement shall not be treated
as a Federal contractor or subcontractor by the Office of Federal
Contract Compliance Programs of the Department of Labor based on the
work performed or actions taken by such eligible provider that resulted
in the receipt of such payments.
``(g) Termination of Veterans Care Agreement.--(1) An eligible
provider may terminate a Veterans Care Agreement with the Secretary
under this section at such time and upon such notice to the Secretary
as the Secretary may specify for purposes of this section.
``(2) The Secretary may terminate a Veterans Care Agreement with an
eligible provider under this section at such time and upon such notice
to the eligible provider as the Secretary may specify for the purposes
of this section, if the Secretary--
``(A) determines that the eligible provider failed to
comply with the provisions of the agreement or this section or
other applicable provision of law;
``(B) makes a revocation pursuant to subsection (d)(1)(4);
``(C) ascertains that the eligible provider has been
convicted of a felony or other serious offense under Federal or
State law and determines that the continued participation of
the eligible provider would be detrimental to the best
interests of veterans of the Department; or
``(D) determines that it is reasonable to terminate the
agreement based on the health care needs of veterans.
``(h) Duration; Mandatory Reviews.--(1) Each Veterans Care
Agreement entered into under this section shall be for a two-year
period unless the Secretary extends the agreement pursuant to paragraph
(2)(B).
``(2)(A) During the 180-day period beginning 540 days after the
date on which a Veterans Care Agreement is entered into or renewed, the
Secretary shall review the agreement to determine whether it is
feasible and advisable to instead furnish the hospital care, medical
services, or extended care furnished under the agreement at facilities
of the Department or through contracts or sharing agreements entered
into under authorities other than this section.
``(B) If the Secretary determines under subparagraph (A) that it is
not feasible and advisable to instead furnish hospital care, medical
services, or extended care furnished under a Veterans Care Agreement at
facilities of the Department or through contracts or sharing agreements
entered into under authorities other than this section, the Secretary--
``(i) shall prepare a written memorandum of such
determination; and
``(ii) may renew such agreement.
``(i) Disputes.--(1) The Secretary shall establish administrative
procedures for eligible providers with which the Secretary has entered
into a Veterans Care Agreement to present any dispute arising under or
related to the agreement.
``(2) Before using any dispute resolution mechanism under chapter
71 of title 41 with respect to a dispute arising under a Veterans Care
Agreement under this section, an eligible provider must first exhaust
the administrative procedures established by the Secretary under
paragraph (1).
``(j) Annual Reports.--Not later than October 1 of the year
following the fiscal year in which the Secretary first enters into a
Veterans Care Agreement, and each year thereafter, the Secretary shall
submit to the appropriate congressional committees an annual report
that includes--
``(1) a list of all Veterans Care Agreements entered into
as of the date of the report; and
``(2) summaries of each determination made by the Secretary
under subsection (h)(2) during the fiscal year covered by the
report.
``(k) Quality of Care.--In carrying out this section, the Secretary
shall use the quality of care standards set forth or used by the
Centers for Medicare & Medicaid Services.
``(l) Delegation.--The Secretary may delegate the authority to
enter into or terminate a Veterans Care Agreement, or to make a
determination described in subsection (h)(2), at a level not below the
Assistant Deputy Under Secretary for Health for Community Care.
``(m) Sunset.--The Secretary may not enter into or renew a Veterans
Care Agreement under this section after the date that is five years
after the enactment of this Act.
``(n) Definitions.--In this section:
``(1) The term `appropriate congressional committees'
means--
``(A) the Committees on Veterans' Affairs of the
House of Representatives and the Senate; and
``(B) the Committees on Appropriations of the House
of Representatives and the Senate.
``(2) The term `eligible provider' means a provider of
hospital care, medical services, or extended care that the
Secretary determines is eligible to enter into Veterans Care
Agreements under subsection (c).
``(3) The term `Veterans Care Agreement' means an agreement
entered into by the Secretary with an eligible provider under
subsection (a)(1).''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item related
to section 1703 the following new item:
``1703A. Veterans Care Agreements with certain health care
providers.''.
(c) Regulations.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
prescribe interim final regulations to implement section 1703A of title
38, United States Code, as added by subsection (a), and publish such
regulations in the Federal Register.
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