115 HR 4242 IH: VA Care in the Community Act
U.S. House of Representatives
2017-11-03
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)This Act may be cited as the VA Care in the Community Act
. (b)The table of contents for this Act is as follows:
Sec. 1. Short title; table of contents.
Title I—Improved access for veterans to non-Department of Veterans Affairs medical care
Sec. 101. Assignment of veterans to primary care providers.
Sec. 102. Establishment of VA Care in the Community Program.
Sec. 103. Veterans Care Agreements.
Sec. 104. Modification of authority to enter into agreements with State homes to provide nursing
home care.
Sec. 105. Department of Veterans Affairs electronic interface for processing of medical claims.
Sec. 106. Funding for VA Care in the Community Program.
Sec. 107. Termination of certain provisions authorizing medical care to veterans through
non-Department of Veterans Affairs providers.
Sec. 108. Implementation and transition.
Title II—Other administrative matters
Sec. 201. Reimbursement for emergency ambulance services.
Sec. 202. Improvement of care coordination for veterans through exchange of certain medical
records.
Sec. 203. Elimination of copayment offset.
Sec. 204. Use of Department of Veterans Affairs Medical Care Collections Fund for certain
improvements in collections.
Sec. 205. Department of Veterans Affairs health care productivity improvement.
Sec. 206. Licensure of health care professionals of the Department of Veterans Affairs providing
treatment via telemedicine.
<enum>I</enum><header>Improved access for veterans to non-Department of Veterans Affairs medical care</header>
<section id="HC131BA93B0D848BFAD571AE148F244C5"><enum>101.</enum><header>Assignment of veterans to primary care providers</header><text display-inline="no-display-inline">Section 1706 of title 38, United States Code, is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H30D293FA0D64402CB7A081939C8BF5D3" style="USC">
<subsection id="HAFE5C95DA72B428EB773BD54A61D5C94"><enum>(d)</enum>
<paragraph commented="no" display-inline="yes-display-inline" id="HD8D7C801E5D2445FB4F06A416EC92F4B"><enum>(1)</enum><text>Except as provided in section 1703A of this title, in furnishing primary care under this chapter, the Secretary shall assign each eligible veteran to—</text>
<subparagraph id="H31B4FBB60CF34A04A3510A460B301E9A" indent="up1"><enum>(A)</enum><text>a patient-aligned care team of the Department; or</text> </subparagraph><subparagraph id="HFA96E10472894147893411C9BFE39EFF" indent="up1"><enum>(B)</enum><text>a dedicated primary care provider of the Department as a part of any other model of providing consistent primary care determined appropriate by the Secretary.</text>
</subparagraph></paragraph><paragraph commented="no" id="H5967A351C6E54E99B979581101895372" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">Each patient-aligned care team of the Department shall consist of a team of health care professionals of the Department who—</text>
<subparagraph commented="no" id="H7EE68C62B09A47D5886C8DB4F8CE8DFC"><enum>(A)</enum><text>provide to each eligible veteran comprehensive primary care in partnership with the veteran; and</text> </subparagraph><subparagraph commented="no" id="H4B81A553D2694633B991F74893CF8EE8"><enum>(B)</enum><text>manage and coordinate comprehensive hospital care and medical services consistent with the goals of care agreed upon by the veteran and team.</text>
</subparagraph></paragraph><paragraph id="HABC6E11CE58C4300A804E04A7447D2AC" indent="up1"><enum>(3)</enum><text>The Secretary shall ensure that an eligible veteran is not simultaneously assigned to more than one patient-aligned care team or dedicated primary care provider under this subsection at a single location, including by establishing procedures in the event a primary care provider retires or is otherwise no longer able to treat the veteran. In the case of an eligible veteran who resides in more than one location, the Secretary may assign such veteran to a patient-aligned care team or dedicated primary care provider at each such location.</text>
</paragraph><paragraph display-inline="no-display-inline" id="H8E2C774651FB4E9DA46775D10C20F0EA" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">The term <term>eligible veteran</term> means a veteran who—</text> <subparagraph id="HFAA95E1BF4054BBB981219DA4D8C2406"><enum>(A)</enum><text>is enrolled in the patient enrollment system of the Department established and operated under section 1705(a) of this title; and</text>
</subparagraph><subparagraph id="H9021200B3A3A426DB65A245021BEFFD4"><enum>(B)</enum><text>has—</text> <clause id="H9DB9D843B5EB41AE9141BF76470DA8FD"><enum>(i)</enum><text>been furnished hospital care or medical services at or through a Department facility on at least one occasion during the two-year period preceding the date of the determination of eligibility; or</text>
</clause><clause id="H2838424F8D6C46D78E574E38B351003A"><enum>(ii)</enum><text>requested a first-time appointment for hospital care or medical services at a Department facility.</text></clause></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </section><section id="HB7C14601E8E24549973596F0F3A686DA"><enum>102.</enum><header>Establishment of VA Care in the Community Program</header> <subsection id="H7FC534EC71FA4A17A733D6E1854BDD8B"><enum>(a)</enum><header>Establishment of program</header> <paragraph id="HB3996312243D4CF9A16E9E206D10BC35"><enum>(1)</enum><header>In general</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">Chapter 17</external-xref> of title 38, United States Code, is amended by inserting after <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703</external-xref> the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H02F52FFA011A48CCA4D8241D7D4C350D" style="USC">
<section id="H8B9FDF8518E041708B82B444EDAF790F"><enum>1703A.</enum><header>VA Care in the Community Program</header>
<subsection id="H1EAF7BF3784848779185D45EBED7A2B9"><enum>(a)</enum><header>Program</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H9DAD999ECBCB4C778C4C5EAE7D49FC9F"><enum>(1)</enum><text display-inline="yes-display-inline">Subject to the availability of appropriations for such purpose, hospital care, medical services, and extended care services under this chapter shall be furnished to an eligible veteran through contracts or agreements authorized under subsection (d), or contracts or agreements, including national contracts or agreements, authorized under section 8153 of this title or any other provision of law administered by the Secretary, with network providers for the furnishing of such care and services to veterans.</text>
</paragraph><paragraph commented="no" id="HD30659ECBA2C4B078F85F7446AE2E89F" indent="up1"><enum>(2)</enum><text>Subject to subsection (b), an eligible veteran may select a provider of such care or services from among network providers.</text>
</paragraph><paragraph id="H656819F92C8440ADA4D6329DDB366082" indent="up1"><enum>(3)</enum><text>The Secretary shall coordinate the furnishing of care and services under this section to eligible veterans.</text>
</paragraph><paragraph commented="no" id="HA3D926EDF924402093B6ADD1FD8EC382" indent="up1"><enum>(4)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H9ACF11F64E4D4A4E816289A18AB1407B"><enum>(A)</enum><text>In carrying out this section, the Secretary shall establish regional networks of network providers. The Secretary shall determine, and may modify, such regions based on the capacity and market assessments of Veterans Integrated Service Networks conducted under subsection (k) or upon recognized need.</text>
</subparagraph><subparagraph commented="no" id="HDE1B7145EF9B4A088EA11B9BF4E37C57" indent="up1"><enum>(B)</enum><text>The Secretary may enter into one or more contracts for the purposes of managing the operations of the regional networks and for the delivery of care pursuant to this section.</text>
</subparagraph></paragraph></subsection><subsection id="H94BD0DE9C5AF425CA0A9AF318722A535"><enum>(b)</enum><header>Primary and specialty care</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H0530C54B7C1146B3BD3E0D1292B4084F"><enum>(1)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H96B16A6D22014E88B9F2DCB166CF35B2"><enum>(A)</enum><text>If the Secretary is unable to assign an eligible veteran to a patient-aligned care team or dedicated primary care provider under section 1706(d) of this title because the Secretary determines such a care team or provider at a Department facility is not available—</text>
<clause commented="no" display-inline="no-display-inline" id="H326B417C62FE4FD48E9AFE821392EC0C" indent="up2"><enum>(i)</enum><text>the Secretary shall consult with the veteran regarding available primary care providers from among network providers that are located in the regional network in which the veteran resides or a regional network that is adjacent to the regional network in which the veteran resides; and</text>
</clause><clause commented="no" display-inline="no-display-inline" id="H4BB98C423690438F9D535A116D00A83C" indent="up2"><enum>(ii)</enum><text display-inline="yes-display-inline">the veteran may select one of the available primary care providers to serve as the dedicated primary care provider of the veteran.</text>
</clause></subparagraph><subparagraph id="H4CD3A0588FE14FEAA3B5995FCE22D580" indent="up2"><enum>(B)</enum><text>In determining whether a patient-aligned care team or dedicated provider under section 1706(d) of this title is available for assignment to a veteran, the Secretary shall take into consideration each of the following:</text>
<clause id="H1AD8D7D6B2C7472AA415199DB7850B5B"><enum>(i)</enum><text display-inline="yes-display-inline">Whether the veteran faces an unusual or excessive burden in accessing such patient-aligned care team or dedicated provider at a medical facility of the Department including with respect to—</text>
<subclause id="H250FB7555E86461BB42432DEDBA22B0A"><enum>(I)</enum><text>geographical challenges;</text> </subclause><subclause id="H27B57C16513A4FCBAE69B0BA9DA783F1"><enum>(II)</enum><text>environmental factors, including roads that are not accessible to the general public, traffic, or hazardous weather;</text>
</subclause><subclause id="HFA8F1D0E25664599AA863204522D5B79"><enum>(III)</enum><text>a medical condition of the veteran; or</text> </subclause><subclause id="HE7DE01BC440E420FAB66D513A8A7EE7D"><enum>(IV)</enum><text display-inline="yes-display-inline">such other factors as determined by the Secretary.</text>
</subclause></clause><clause id="HA89EF358A64B48D2A1FA750F872B9A8C"><enum>(ii)</enum><text>Whether the veteran reasonably believes that the assignment of a particular care team or provider to the veteran would detrimentally affect the patient-provider relationship and result in sub-optimal care to the veteran.</text>
</clause><clause id="HB243CA073A59434AB0AC9DB0CF516206"><enum>(iii)</enum><text>Whether the panel size of the care team or provider is at such a number that it would result in difficulty for the veteran in accessing timely care or in sub-optimal care to the veteran.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H4DB0BC3F84074B8DBFB85B2EF59A7F71" indent="up2"><enum>(C)</enum><text display-inline="yes-display-inline">If the Secretary determines that a patient-aligned care team or dedicated primary care provider at a Department facility has become available for assignment to an eligible veteran who had been assigned to a network provider under subparagraph (A), the Secretary shall provide the veteran with the option of reassignment to the team or provider at the Department facility.</text>
</subparagraph><subparagraph id="HF0D29142D9F64802B6781DDACA1A9C6B" indent="up2"><enum>(D)</enum><text>In the case of an eligible veteran who is assigned to a network provider under subparagraph (A), the Secretary shall reevaluate such assignment not earlier than one year after a veteran makes a selection under subparagraph (A)(ii), and on an annual basis thereafter, to—</text>
<clause commented="no" id="H3C5B6E2DD91C4645865E2705AF818F10"><enum>(i)</enum><text>determine whether the Secretary is able to assign to the veteran a patient-aligned care team or dedicated primary care provider under section 1706(d) of this title; and</text>
</clause><clause commented="no" id="H63028CEBD562444FA4E378D8E1907512"><enum>(ii)</enum><text>in consultation with and upon approval of the veteran, make such assignment if able.</text> </clause></subparagraph></paragraph><paragraph display-inline="no-display-inline" id="HC7BC6CB33D29421F852B8F3236B847E1" indent="up1"><enum>(2)</enum> <subparagraph commented="no" display-inline="yes-display-inline" id="H5BC27EE5ACCF4CCE98C61A6C71CC3877"><enum>(A)</enum> <clause commented="no" display-inline="yes-display-inline" id="H98435A3456664C24BBC1396C91B779F5"><enum>(i)</enum><text>Except as provided in clause (ii), the Secretary may only furnish specialty hospital care, medical services, or extended care services to an eligible veteran under this section pursuant to a referral for such specialty care or services made by the primary care provider of the veteran.</text>
</clause><clause id="HF283989DC83A44F88EDA3DD0BA3146DF" indent="up2"><enum>(ii)</enum><text>The Secretary may designate specialties which shall be exempt from the requirement under clause (i).</text>
</clause></subparagraph><subparagraph commented="no" id="HF2E678B76CFC430999EC850ED847CF1E" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">The Secretary shall determine whether to furnish specialty hospital care, medical services, or extended care services to an eligible veteran pursuant to subparagraph (A)—</text>
<clause id="HC4217641773D4DCFA314563CEAAC36EC"><enum>(i)</enum><text display-inline="yes-display-inline">at a medical facility of the Department that is within a reasonable distance of the residence of the veteran, as determined by the Secretary;</text>
</clause><clause id="HBAEF225B657E42549621F4840BC7098D"><enum>(ii)</enum><text display-inline="yes-display-inline">by a network provider that, to the greatest extent practicable, is located in the regional network in which the veteran resides or a regional network that is adjacent to the regional network in which the veteran resides; or</text>
</clause><clause commented="no" id="H74398BC1957A4A5CA8DBBDF26A8299A3"><enum>(iii)</enum><text display-inline="yes-display-inline">pursuant to an agreement described in subparagraph (C).</text> </clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H1C22B9EDBE7F4A04BEC6BFE84B03EC5C" indent="up1"><enum>(C)</enum><text>An agreement described in this subparagraph is an agreement entered into by the Secretary with a network provider under which—</text>
<clause commented="no" id="HAE01EE64259445B79236DC3B54E15C34"><enum>(i)</enum><text display-inline="yes-display-inline">specialty hospital care, medical services, or extended care services are furnished to an eligible veteran pursuant to subparagraph (A)—</text>
<subclause commented="no" id="HCF26D1DAD3B446FC94D8B28BA32A5599"><enum>(I)</enum><text display-inline="yes-display-inline">at a medical facility of the Department by a network provider possessing the appropriate credentials, as determined by the Secretary; or</text>
</subclause><subclause commented="no" id="H1E3B5CABE45646B09309E315837E4CEB"><enum>(II)</enum><text display-inline="yes-display-inline">at a facility of a network provider by a health care provider of the Department; and</text> </subclause></clause><clause commented="no" id="HDA0A0C3D203A48A6A441E3EEF7C7DCB4"><enum>(ii)</enum><text>such specialty care or services are so furnished either—</text>
<subclause commented="no" id="H2185AC26A9EF42DEA8434D8B1D4C5D75"><enum>(I)</enum><text display-inline="yes-display-inline">in accordance with this section with respect to fees and payments for care and services furnished under subsection (a); or</text>
</subclause><subclause commented="no" id="HFE47CA8FBBE049979C83ED090A28B21B"><enum>(II)</enum><text>at no cost to the United States.</text> </subclause></clause></subparagraph><subparagraph id="HFF14DB8452184F35AA3B4B929040C19D" indent="up1"><enum>(D)</enum><text>In making the determination under subparagraph (B), the Secretary shall give priority to medical facilities and health care providers of the Department but shall take into account—</text>
<clause id="H2200D7582B5E40C780E4D5B15D83D80D"><enum>(i)</enum><text>whether the veteran faces an unusual or excessive burden in accessing such specialty hospital care, medical services, or extended care services at a medical facility of the Department, including with respect to—</text>
<subclause id="H03359681CE6947958181F46715BF0E68"><enum>(I)</enum><text>geographical challenges;</text> </subclause><subclause id="H2B3BEEA018AE4099B0137D86C6123AAF"><enum>(II)</enum><text>environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather;</text>
</subclause><subclause id="H2BF23C3C1241492982F81BC1C12227B9"><enum>(III)</enum><text>a medical condition of the veteran; or</text> </subclause><subclause id="H9F468C4E37FE40408ECB359A755C666E"><enum>(IV)</enum><text>such other factors as determined by the Secretary; and</text>
</subclause></clause><clause commented="no" id="HF13889820F834FCA98F7131737B1C41D"><enum>(ii)</enum><text display-inline="yes-display-inline">whether the primary care provider of the veteran recommends that such specialty hospital care, medical services, or extended care services should be furnished by a network provider.</text>
</clause></subparagraph><subparagraph commented="no" id="HA64B5ECB248E4B448A41B4C85B939052" indent="up1"><enum>(E)</enum><text display-inline="yes-display-inline">The Secretary shall ensure that each medical facility of the Department processes referrals for specialty hospital care, medical services, or extended care services in a standardized manner, including with respect to the organization of the program office responsible for such referrals.</text>
</subparagraph><subparagraph id="H2AFA94ACF92E4366B7371FD1238DC169" indent="up1"><enum>(F)</enum><text display-inline="yes-display-inline">In carrying out this section, the Secretary shall establish a process to review any disagreement between an eligible veteran and the Department, or between an eligible veteran and a health care provider of the Department, regarding the eligibility of the veteran to receive care or services from a network provider under this section or the assignment of a primary care provider of the Department to the veteran. In reviewing a disagreement under such process with respect to the availability of and assignment to a patient aligned care team or dedicated primary care provider, the Secretary shall give deference to the veteran with respect to any determination under subsection (b)(1)(B)(ii).</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="H66757F48F35B417F9B1C35215F621BA3"><enum>(c)</enum><header>Episodes of care</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HAE7E20940B094AAA872E14D952991A5B"><enum>(1)</enum><text>The Secretary shall ensure that, at the election of an eligible veteran who receives hospital care, medical services, or extended care services from a network provider in an episode of care under this section, the veteran receives such care or services from that network provider, another network provider selected by the veteran, or a health care provider of the Department, through the completion of the episode of care, including all specialty and ancillary services determined necessary by the provider as part of the treatment recommended in the course of such care or services. In making such determination with respect to necessary specialty and ancillary services provided by a network provider, the network provider shall consult with the Secretary, acting through the program office of the appropriate medical facility.</text>
</paragraph><paragraph commented="no" id="HD052E24203B64083B78242479FBA905D" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">In cases of episodes of care that the Secretary determines case management to be appropriate, the Secretary shall provide case management to an eligible veteran who receives hospital care, medical services, or extended care services from a network provider for such episodes of care. The Secretary may provide such case management through the Veterans Health Administration or through an entity that manages the operations of the regional networks pursuant to subsection (a)(4)(B).</text>
</paragraph></subsection><subsection id="HBD8B7B352D154FC7A452DF2D00FC407B"><enum>(d)</enum><header>Care and services through contracts and agreements</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H577A826E78A743C3987B74C9D323C89B"><enum>(1)</enum><text display-inline="yes-display-inline">The Secretary shall enter into contracts or agreements, including national contracts or agreements for, but not limited to, dialysis, for furnishing care and services to eligible veterans under this section with network providers.</text>
</paragraph><paragraph id="H9764691DA7C845AC89BA088E894F1706" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H861824FDB10546D4A63FFCEBF3F434D4"><enum>(A)</enum><text display-inline="yes-display-inline">In entering into a contract or agreement under paragraph (1) with a network provider, the Secretary shall—</text>
<clause display-inline="no-display-inline" id="H8E28C9EDF1AF4EFEAB99CE6A96B1661E" indent="up1"><enum>(i)</enum><text>negotiate rates for the furnishing of care and services under this section; and</text> </clause><clause id="H72CCEF97FC9F4923B199B3E4FB8C9F17" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">reimburse the provider for such care and services at the rates negotiated pursuant to clause (i) as provided in such contract or agreement.</text>
</clause></subparagraph><subparagraph display-inline="no-display-inline" id="H1180E92608224D75AB4AAD05553F2BEB" indent="up1"><enum>(B)</enum>
<clause commented="no" display-inline="yes-display-inline" id="HA3473DB4D99C4380844849E9FCCCBC0B"><enum>(i)</enum><text>Except as provided in paragraph (3), rates negotiated under subparagraph (A)(i) shall not be more than the rates paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(u)</external-xref>)) or a supplier (as defined in section 1861(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(d)</external-xref>)) under the Medicare Program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) for the same care or services.</text>
</clause><clause commented="no" id="HF11EADAE04564BF485AE9EBD4D2F31FE" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">In determining the rates under the Medicare Program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) for purposes of clause (i), in the case of care or services furnished by a provider of services with respect to which such rates are determined under a fee schedule to which the area wage index under section 1886(d)(3)(E) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395ww">42 U.S.C. 1395ww(d)(3)(E)</external-xref>) applies, such area wage index so applied to such provider of services may not be less than 1.00.</text>
</clause></subparagraph><subparagraph commented="no" id="HDB70F01EE94A4FA38C460998DE8196A9" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">In carrying out paragraph (2), the Secretary may incorporate the use of value-based reimbursement models to promote the provision of high-quality care.</text>
</subparagraph></paragraph><paragraph id="HF5FCEFB7F68F4D20ADB03158B9A38C21" indent="up1"><enum>(3)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HD5371736D71546DB9E784A70D715ABAD"><enum>(A)</enum><text display-inline="yes-display-inline">With respect to the furnishing of care or services under this section to an eligible veteran who resides in a highly rural area (as defined under the rural-urban commuting area codes developed by the Secretary of Agriculture and the Secretary of Health and Human Services), the Secretary of Veterans Affairs may negotiate a rate that is more than the rate paid by the United States as described in paragraph (2)(B).</text>
</subparagraph><subparagraph id="H20238762FC9C4FCB81C0B7BF90F07234" indent="up1"><enum>(B)</enum><text>With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs will be followed, except for when another payment agreement, including a contract or provider agreement, is in place.</text>
</subparagraph><subparagraph id="H49707AF8A93D46BCBADB05B9B46C758D" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">With respect to furnishing care or services under this section in a State with an All-Payer Model Agreement under the Social Security Act that became effective on or after January 1, 2014, the Medicare payment rates under paragraph (2)(B) shall be calculated based on the payment rates under such agreement, or any such successor agreement.</text>
</subparagraph><subparagraph id="H7027A79C158F4FBD8C5AA3F5E1B5E571" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">With respect to furnishing care or services under this section in a location in which the Secretary determines that adjusting the rate paid by the United States as described in paragraph (2)(B) is appropriate, the Secretary may negotiate such an adjusted rate.</text>
</subparagraph><subparagraph id="HA829C368606542908D5BC715609E74A1" indent="up1"><enum>(E)</enum><text display-inline="yes-display-inline">With respect to furnishing care or services under this section in a location or in a situation in which an exception to the rates paid by the United States under the Medicare Program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) for the same care or services applies, the Secretary may follow such exception.</text>
</subparagraph><subparagraph id="H20B4295560AE40AAB265988F6D9B15AF" indent="up1"><enum>(F)</enum><text display-inline="yes-display-inline">With respect to furnishing care or services under this section for care or services not covered under the Medicare Program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.), the Secretary shall establish a schedule of fees for such care or services.</text>
</subparagraph><subparagraph id="H89C303BFCACC4872A6B431B39A3711A6" indent="up1"><enum>(G)</enum><text>With respect to furnishing care or services under this section pursuant to an agreement with a tribal or Federal entity, the Secretary may negotiate a rate that is more than the rate paid by the United States as described in paragraph (2)(B).</text>
</subparagraph></paragraph><paragraph id="H5F5A77770AC746D1B2496B64BF2CEA75" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">For the furnishing of care or services pursuant to a contract or agreement under paragraph (1), a network provider may not collect any amount that is greater than the rate negotiated pursuant to paragraph (2)(A).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H87EEA28CA05641EB91607F1E672CB069" indent="up1"><enum>(5)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H557A8FC20F244FD79EA2B48A4578F0CF"><enum>(A)</enum><text display-inline="yes-display-inline">If, in the course of an episode of care under this section, any part of care or services is furnished by a medical provider who is not a network provider, the Secretary may compensate such provider for furnishing such care or services.</text>
</subparagraph><subparagraph commented="no" id="H64A5ED34512A4B61A9499A90F63E8B9F" indent="up1"><enum>(B)</enum><text>The Secretary shall make reasonable efforts to enter into a contract or agreement under this section with any provider who is compensated pursuant to subparagraph (A).</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H16FEDA9667624404B93FA67E482D601F"><enum>(e)</enum><header>Prompt payment standard</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H65D24A3976A24253AA92264108E04DC9"><enum>(1)</enum>
<text display-inline="yes-display-inline">The Secretary shall ensure that claims for payments for hospital care, medical services, or extended care services furnished under this section are processed in accordance with this subsection, regardless of whether such claims are—</text>
<subparagraph id="H566202EFDBB3475C9B06E4B5A78BDF5C" indent="up1"><enum>(A)</enum><text>made by a network provider to the Secretary;</text> </subparagraph><subparagraph id="H2EE719C493304BE69C3E0B7E74CD2D88" indent="up1"><enum>(B)</enum><text>made by a network provider to a regional network operated by a contractor pursuant to subsection (a)(4)(B); or</text>
</subparagraph><subparagraph id="HFE2D96C6BF514F1893395B9FB6846533" indent="up1"><enum>(C)</enum><text>made by such a regional network to the Secretary.</text> </subparagraph></paragraph><paragraph id="HA85CE064746A4A77A06BFC34841D5D13" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">A covered claimant that seeks payment for hospital care, medical services, or extended care services furnished under this section shall submit to the covered payer a claim for payment not later than—</text>
<subparagraph id="H7C403BFD9E144DE88967BB1FA5837294"><enum>(A)</enum><text>with respect to a claim by a network provider, 180 days after the date on which the network provider furnishes such care or services; or</text>
</subparagraph><subparagraph id="H9FB839819A0248E086E24567C06958A2"><enum>(B)</enum><text>with respect to a claim by a regional network operated by a contractor, 180 days after the date on which the contractor pays the network provider for furnishing such care or services.</text>
</subparagraph></paragraph><paragraph commented="no" id="HC235381D4B4A4FD7876AD1268BDD3502" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">Notwithstanding <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/31/39">chapter 39</external-xref> of title 31 or any other provision of law, the covered payer shall pay a covered claimant for hospital care, medical services, or extended care services furnished under this section—</text>
<subparagraph commented="no" id="HB0481DA7EC16497C8EEAD5DAE9C7A855"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of a clean claim submitted to the covered payer on paper, not later than 45 calendar days after receiving the claim; or</text>
</subparagraph><subparagraph commented="no" id="H5F4133406C044CCA88930827BC834349"><enum>(B)</enum><text display-inline="yes-display-inline">in the case of a clean claim submitted to the covered payer electronically, not later than 30 calendar days after receiving the claim.</text>
</subparagraph></paragraph><paragraph commented="no" id="H1C0A90359E7443AFB93954BCF5F4C322" indent="up1"><enum>(4)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H9DC21A49B6DC49AEAF6623FECFCA5185"><enum>(A)</enum><text display-inline="yes-display-inline">If the covered payer denies a claim submitted by a covered claimant under paragraph (1), the covered payer shall notify the covered claimant of the reason for denying the claim and the additional information, if any, that may be required to process the claim—</text>
<clause commented="no" id="HC0B8B9D50E8A48B79470E4993D06CC18" indent="up1"><enum>(i)</enum><text display-inline="yes-display-inline">in the case of a clean claim submitted to the covered payer on paper, not later than 45 calendar days after receiving the claim; or</text>
</clause><clause commented="no" id="H1B3D8B70ED5B443488C9DCAACECEF772" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">in the case of a clean claim submitted to the covered payer electronically, not later than 30 calendar days after receiving the claim.</text>
</clause></subparagraph><subparagraph commented="no" id="H0770A8FDF1DD41608A67C25EE2153BB7" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">Upon receipt by the covered payer of additional information specified under subparagraph (A) relating to a claim, the covered payer shall pay, deny, or otherwise adjudicate the claim, as appropriate, not later than 30 calendar days after receiving such information.</text>
</subparagraph></paragraph><paragraph commented="no" id="HEAFD181ED70246688B08F04735B77F67" indent="up1"><enum>(5)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HD342E3D968EC495B8EB069CDBEED6346"><enum>(A)</enum><text display-inline="yes-display-inline">If the covered payer has not paid a covered claimant or denied a clean claim for payment by the covered claimant under this subsection during the appropriate period specified in this subsection, such clean claim shall be considered overdue.</text>
</subparagraph><subparagraph commented="no" id="HF2C5F6175827493398619B535F470782" indent="up1"><enum>(B)</enum><text>If a clean claim for payment by a covered claimant is considered overdue under subparagraph (A), in addition to the amount the covered payer owes the covered claimant under the claim, the covered payer shall owe the covered claimant an interest penalty amount that shall—</text>
<clause commented="no" id="HD39784BF7FA3499393BD5B461D319200"><enum>(i)</enum><text display-inline="yes-display-inline">be prorated daily;</text> </clause><clause commented="no" id="H6EEF885082CE452AA6DCC1DF442EDD20"><enum>(ii)</enum><text display-inline="yes-display-inline">accrue from the date the payment was overdue;</text>
</clause><clause commented="no" id="HC5A9CA1B292A4300AFC2B20F91A2168E"><enum>(iii)</enum><text display-inline="yes-display-inline">be payable at the time the claim is paid; and</text> </clause><clause commented="no" id="H1933C7C399334325970FB66E8EF43EBD"><enum>(iv)</enum><text display-inline="yes-display-inline">be computed at the rate of interest established by the Secretary of the Treasury, and published in the Federal Register, for interest payments under subsections (a)(1) and (b) of section 7109 of title 41 that is in effect at the time the covered payer accrues the obligation to pay the interest penalty amount.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H6802100AF451441AA944481F87D1CB86" indent="up1"><enum>(6)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HFF9C63C4358243819DD44354513E4F77"><enum>(A)</enum><text display-inline="yes-display-inline">If the covered payer overpays a covered claimant for hospital care, medical services, or extended care services furnished under this section—</text>
<clause id="H152E984293F249FF8F810CAF9A8E71AF" indent="up1"><enum>(i)</enum><text display-inline="yes-display-inline">the covered payer shall deduct the amount of any overpayment from payments due to the covered claimant after the date of such overpayment; or</text>
</clause><clause id="H9425892A242B4C1E8236736F5BA74861" indent="up1"><enum>(ii)</enum><text>if the covered payer determines that there are no such payments due after the date of the overpayment, the covered claimant shall refund the amount of such overpayment not later than 30 days after such determination.</text>
</clause></subparagraph><subparagraph commented="no" id="H27A4487599F04741A548BDD0DAE9E16B" indent="up1"><enum>(B)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H155E1A48CD8843D0A226890898155148"><enum>(i)</enum><text>Before deducting any amount from a payment to a covered claimant under subparagraph (A), the covered payer shall ensure that the covered claimant is provided an opportunity—</text>
<subclause commented="no" id="H22EE36ED7BC046FAA2E8F5DB7D3831B6" indent="up1"><enum>(I)</enum><text>to dispute the existence or amount of any overpayment owed to the covered payer; and</text> </subclause><subclause commented="no" id="HB1AC7F6C9BE2478884D648ECA5D2441C" indent="up1"><enum>(II)</enum><text>to request a compromise with respect to any such overpayment.</text>
</subclause></clause><clause commented="no" id="H5AC964EF08644689936F23E596F96798" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">The covered payer may not make any deduction from a payment to a covered claimant under subparagraph (A) unless the covered payer has made reasonable efforts to notify the covered claimant of the rights of the covered claimant under subclauses (I) and (II) of clause (i).</text>
</clause><clause commented="no" id="H484C65154D994FC0B28913EBB98A2E6B" indent="up1"><enum>(iii)</enum><text display-inline="yes-display-inline">Upon receiving a dispute under subclause (I) of clause (i) or a request under subclause (II) of such clause, the covered payer shall make a determination with respect to such dispute or request before making any deduction under subparagraph (A) unless the time required to make such a determination would jeopardize the ability of the covered payer to recover the full amount owed to the covered payer.</text>
</clause></subparagraph></paragraph><paragraph commented="no" id="H0D073600098F4C3997A226F38F977A5E" indent="up1"><enum>(7)</enum><text display-inline="yes-display-inline">Notwithstanding any other provision of law, the Secretary may, except in the case of a fraudulent claim, false claim, or misrepresented claim, compromise any claim of an amount owed to the United States under this section.</text>
</paragraph><paragraph commented="no" id="H8740B388FFF149A4B91EAC675583A383" indent="up1"><enum>(8)</enum><text display-inline="yes-display-inline">This subsection shall apply only to payments made on a claims basis and not to capitation or other forms of periodic payments to network providers.</text>
</paragraph><paragraph id="H881EDC201DDE454E9AFCE64F011891ED" indent="up1"><enum>(9)</enum><text>A network provider that provides hospital care, medical services, or extended care services to an eligible veteran under this section may not seek any payment for such care or services from the eligible veteran.</text>
</paragraph><paragraph id="HA38EAED1D60640139C942B1A8B81E829" indent="up1"><enum>(10)</enum><text>With respect to making a payment for hospital care or medical services furnished to an eligible veteran by a network provider under this section—</text>
<subparagraph id="HCC7D3F5DC9F04948ABC57F7A7F0B5C31"><enum>(A)</enum><text>the Secretary may not require receipt by the veteran or the Department of a medical record under subsection (g) detailing such care or services before a covered payer makes a payment for such care or services; and</text>
</subparagraph><subparagraph commented="no" id="H6C1C16D315B3412EB1752DEAE2028A8F"><enum>(B)</enum><text>the Secretary may require that the network provider attests to such care or services so provided before a covered payer makes a payment for such care or services.</text>
</subparagraph></paragraph></subsection><subsection id="H3C13D67EC8474F43A1876EB5BDAEB0E0"><enum>(f)</enum><header>Cost-Sharing</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H528777C35B1B4804A48A41C0C445D82C"><enum>(1)</enum><text>The Secretary shall require an eligible veteran to pay a copayment for the receipt of care or services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department under this chapter.</text>
</paragraph><paragraph id="H22FD7EFF269C4BC1AA687E446B2A3313" indent="up1"><enum>(2)</enum><text>The amount of a copayment charged under paragraph (1) may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department under this chapter.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HA9EE6213DB1B402E923400B1C5D9D36B" indent="up1"><enum>(3)</enum><text>In any case in which an eligible veteran is furnished hospital care or medical services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of this title, the Secretary shall recover or collect reasonable charges for such care or services from a health-plan contract described in section 1705A in accordance with such section 1729.</text>
</paragraph></subsection><subsection id="HEF5CC268DB0A4FA1B8D73C14EB559FED"><enum>(g)</enum><header>Medical records</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HFB88687BBD0841AD94ABEDBFAE72A921"><enum>(1)</enum><text>The Secretary shall ensure that any network provider that furnishes care or services under this section to an eligible veteran—</text>
<subparagraph id="H6F4A545380594D128153612E20DCC7A6" indent="up1"><enum>(A)</enum><text>upon the request of the veteran, provides to the veteran the medical records related to such care or services; and</text>
</subparagraph><subparagraph id="H3BE9560DDA8E40E3AD7A9AA4B3200ECF" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">upon the completion of the provision of such care or services to such veteran, provides to the Department the medical records for the veteran furnished care or services under this section 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.</text>
</subparagraph></paragraph><paragraph id="H7F7CA64EDBE44BF089363476F520CEEB" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">To the extent practicable, the Secretary shall submit to a network provider that furnishes care or services under this section to an eligible veteran the medical records of such eligible veteran that are maintained by the Department and are relevant to such care or services.</text>
</paragraph><paragraph commented="no" id="HB656E53609F54B5FAA8A6C19595955F2" indent="up1"><enum>(3)</enum><text display-inline="yes-display-inline">To the extent practicable, the Secretary shall—</text> <subparagraph id="H8B592A01D0374B59A5F74E922A48C932"><enum>(A)</enum><text>ensure that the medical records shared under paragraphs (1) and (2) are shared in an electronic format accessible by network providers and the Department through an Internet website; and</text>
</subparagraph><subparagraph id="H1C0FEE6E7A1F43118ED55471FAE6C1A8"><enum>(B)</enum><text>provide to network providers access to the electronic patient health record system of the Department, or successor system, for the purpose of furnishing care or services under this section.</text>
</subparagraph></paragraph></subsection><subsection commented="no" id="HFDA12ACDBC044C4ABC4154207BC65839"><enum>(h)</enum><header>Use of card</header><text display-inline="yes-display-inline">The Secretary shall ensure that the veteran health identification card, or such successor identification card, includes sufficient information to act as an identification card for an eligible entity or other non-Department facility. The Secretary may not use any amounts made available to the Secretary to issue separate identification cards solely for the purpose of carrying out this section.</text>
</subsection><subsection id="HC0BA4E648AD84A44A275E8BC04A97B85"><enum>(i)</enum><header>Prescription medications</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H7602E676FB1C4D2BAEB74CC3B549CB75"><enum>(1)</enum><text>With respect to requirements relating to the licensing or credentialing of a network provider, the Secretary shall ensure that the network provider is able to submit prescriptions for pharmaceutical agents on the formulary of the Department to pharmacies of the Department in a manner that is substantially similar to the manner in which the network provider submits prescriptions to retail pharmacies.</text>
</paragraph><paragraph commented="no" id="H1E976F51A73B4D35BDF4FC020D675E9F" indent="up1"><enum>(2)</enum><text>Nothing in this section shall be construed to affect the process of the Department for filling and paying for prescription medications.</text>
</paragraph></subsection><subsection display-inline="no-display-inline" id="H6928F15000314D86B56A591A2B8C4894"><enum>(j)</enum><header>Quality of care</header><text display-inline="yes-display-inline">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 or other quality of care standards, as determined by the Secretary.</text>
</subsection><subsection commented="no" id="H872CF26330FD44FF8E302B41883ED3CA"><enum>(k)</enum><header>Capacity and commercial market assessments</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H2219E45F5819477AA3EDC35F74564C93"><enum>(1)</enum><text>On a periodic basis, but not less often than once every three years, the Secretary shall conduct an assessment of the capacity of each Veterans Integrated Service Network and medical facility of the Department to furnish care or services under this chapter. Each such assessment shall—</text>
<subparagraph commented="no" id="H5B2C56958CB74A59A25FA92C69D49021" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">identify gaps in furnishing such care or services at such Veterans Integrated Service Network or medical facility;</text>
</subparagraph><subparagraph commented="no" id="HD7861B62B55041E7A0C6D3E8C713440F" indent="up1"><enum>(B)</enum><text>identify how such gaps can be filled by—</text> <clause commented="no" id="H8DECBFECD48F4953BC8CBB692176839C"><enum>(i)</enum><text>entering into contracts or agreements with network providers under this section or with entities under other provisions of law;</text>
</clause><clause commented="no" id="H52C1BDD42E344C7FB256C6738C1A2675"><enum>(ii)</enum><text>making changes in the way such care and services are furnished at such Veterans Integrated Service Network or medical facility, including but not limited to—</text>
<subclause id="HDCD111350B0A40188094C429466A7A4F"><enum>(I)</enum><text>extending hours of operation;</text> </subclause><subclause id="H644F985F60984A999C8BB09F752023DE"><enum>(II)</enum><text>adding personnel; or</text>
</subclause><subclause id="H86F606D965664375A2E8C1369D779E5E"><enum>(III)</enum><text>expanding space through construction, leasing, or sharing of health care facilities; and</text> </subclause></clause><clause id="H6A598C0BA6FE4957AA307A83F6C64D13"><enum>(iii)</enum><text display-inline="yes-display-inline">the building or realignment of Department resources or personnel;</text>
</clause></subparagraph><subparagraph commented="no" id="H52E095614CC84599BBF6A5CB222C5103" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">forecast, based on future projections and historical trends, both the short- and long-term demand in furnishing care or services at such Veterans Integrated Service Network or medical facility and assess how such demand affects the needs to use such network providers;</text>
</subparagraph><subparagraph commented="no" id="H98C20EC6E4794B8DBE1D2F528A357E6C" indent="up1"><enum>(D)</enum><text>include a commercial health care market assessment of designated catchment areas in the United States conducted by a nongovernmental entity; and</text>
</subparagraph><subparagraph id="HE69CF1BAADE04FB4B516D0B69F7780D2" indent="up1"><enum>(E)</enum><text>consider the unique ability of the Federal Government to retain a presence in an area otherwise devoid of commercial health care providers or from which such providers are at a risk of leaving.</text>
</subparagraph></paragraph><paragraph commented="no" id="H16A885D2A47A442184370247600B1A33" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">The Secretary shall submit each assessment under paragraph (1) to the Committees on Veterans’ Affairs of the House of Representatives and the Senate and shall make each such assessment publicly available.</text>
</paragraph></subsection><subsection id="H82878B6F3AAB4AF1B2F574DC0B26FA96"><enum>(l)</enum><header>Allocation of funds</header><text>The Secretary shall develop a plan for the allocation of funds in the Medical Community Care account.</text>
</subsection><subsection commented="no" id="H68B433D5B4DD4AE49B55E9D8764F07F9"><enum>(m)</enum><header>Reports on rates</header><text display-inline="yes-display-inline">Not later than December 31, 2019, and annually thereafter during each of the subsequent three years, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report detailing, for the fiscal year preceding the fiscal year during which the report is submitted, the rates paid by the Secretary for hospital care, medical services, or extended care services under this section that, pursuant to subsection (d)(3), are more than the rates described in subsection (d)(2)(B) for the same care or services.</text>
</subsection><subsection id="H272F4C3046624D9784239C7B7133F9CB"><enum>(n)</enum><header>Definitions</header><text>In this section:</text> <paragraph id="HCD5DE3AB8D214AA9BB8D1358D93C964F"><enum>(1)</enum><text>The term <term>clean claim</term> means a claim submitted—</text>
<subparagraph id="H30FF93E8500D4AF0A5F2E12FCE2600B5"><enum>(A)</enum><text>to the covered payer by a covered claimant for purposes of payment by the covered payer of expenses for hospital care or medical services furnished under this section;</text>
</subparagraph><subparagraph id="H907B6C7D5CCC4F7C8C2C576E787FAE7B"><enum>(B)</enum><text>that contains substantially all of the required elements necessary for accurate adjudication, without requiring additional information from the network provider; and</text>
</subparagraph><subparagraph id="H1F80589DD82744F399008B2EF3A1A805"><enum>(C)</enum><text>in such a nationally recognized format as may be prescribed by the Secretary for purposes of paying claims for hospital care or medical services furnished under this section.</text>
</subparagraph></paragraph><paragraph commented="no" id="H2A161EF7E7DE430B8C65BFF9A91F4F31"><enum>(2)</enum><text>The term <term>covered claimant</term> means—</text> <subparagraph commented="no" id="H9084D2B82A354CE0BDCB8646DDC932B1"><enum>(A)</enum><text display-inline="yes-display-inline">a network provider that submits a claim to the Secretary for purposes of payment by the Secretary of expenses for hospital care or medical services furnished under this section; or</text>
</subparagraph><subparagraph commented="no" id="H59633FEA4B3D4F0DBFB1F95F8E1F774E"><enum>(B)</enum><text display-inline="yes-display-inline">a regional network operated by a contractor pursuant to subsection (a)(4)(B) that submits a claim to the Secretary for purposes of reimbursement for a payment made by the contractor to a network provider for hospital care or medical services furnished under this section.</text>
</subparagraph></paragraph><paragraph commented="no" id="HBDAC03E0C93246D9B2401D6D71CC393A"><enum>(3)</enum><text>The term <term>covered payer</term> means—</text> <subparagraph commented="no" id="H0C9BEBC4923E4E9FB3485D326184BC57"><enum>(A)</enum><text display-inline="yes-display-inline">a regional network operated by a contractor pursuant to subsection (a)(4)(B) with respect to a claim made by a network provider to the contractor for purposes of payment by the contractor of expenses for hospital care or medical services furnished under this section; or</text>
</subparagraph><subparagraph commented="no" id="HC727F2859607436899F713443CD8FE3C"><enum>(B)</enum><text>the Secretary with respect to—</text> <clause commented="no" id="HA06CBAC7E26747A9B403278480634C69"><enum>(i)</enum><text display-inline="yes-display-inline">a claim made by a network provider to the Secretary for purposes of payment by the Secretary of expenses for hospital care or medical services furnished under this section; and</text>
</clause><clause commented="no" id="H09760D1A867A4BBA8D08B1860C1C125C"><enum>(ii)</enum><text display-inline="yes-display-inline">a claim made by a regional network operated by a contractor pursuant to subsection (a)(4)(B) for purposes of reimbursement for a payment described by subparagraph (A).</text>
</clause></subparagraph></paragraph><paragraph display-inline="no-display-inline" id="HEC0255FA7762470EB07F80528073538E"><enum>(4)</enum><text display-inline="yes-display-inline">The term <term>eligible veteran</term> means a veteran who—</text> <subparagraph id="HFE316AC33F284ADA92989EC4C602DFDB"><enum>(A)</enum><text>is enrolled in the patient enrollment system of the Department established and operated under section 1705(a) of this title; and</text>
</subparagraph><subparagraph id="H796BD5943EE84A3FA04621CC4171B6CA"><enum>(B)</enum><text>has—</text> <clause id="H40E97186C8CC4F40A2C42DE603F1ACAF"><enum>(i)</enum><text>been furnished hospital care or medical services at or through a Department facility on at least one occasion during the two-year period preceding the date of the determination of eligibility; or</text>
</clause><clause id="H78321A909CA146B18C5B978A3761FD73"><enum>(ii)</enum><text>requested a first-time appointment for hospital care or medical services at a Department facility.</text> </clause></subparagraph></paragraph><paragraph id="H9A500EACC2FE40B2AE2FE440A6CB331D"><enum>(5)</enum><text display-inline="yes-display-inline">The term <term>fraudulent claim</term> means a claim by a network provider for reimbursement under this section that includes an intentional and deliberate misrepresentation of a material fact or facts that is intended to induce the Secretary to pay an amount that was not legally owed to the provider.</text>
</paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HF6948C48272D4CFB8873337BF618F86E"><enum>(2)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1703 the following new item:</text>
<quoted-block id="H46A1F468A0504037A1366D726CE4CBC5" style="USC">
<toc>
<toc-entry idref="H8B9FDF8518E041708B82B444EDAF790F" level="section">1703A. VA Care in the Community Program.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H00CC087A176D4074AB39845FB0C5887C"><enum>(b)</enum><header>Conforming amendments</header><text display-inline="yes-display-inline">The Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>) is amended—</text> <paragraph id="H5FD2BE621CFD46CC87F45F64387FB404"><enum>(1)</enum><text>in section 101(p)(1) (<external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note), by inserting before the period at the end the following: <quote>or the date on which the Secretary certifies to the Committees on Veterans’ Affairs of the House of Representatives and the Senate that the Secretary is fully implementing section 1703A of title 38, United States Code, whichever occurs first</quote>; and</text>
</paragraph><paragraph commented="no" id="H9C00211BD9CF46728A5D777E11D4EC69"><enum>(2)</enum><text>in section 208(1), by striking <quote>section 101</quote> and inserting <quote>section 1703A of title 38, United States Code</quote>.</text> </paragraph></subsection><subsection commented="no" id="H93184FE1F3E3453B92349154BBE6E666"><enum>(c)</enum><header>Definitions</header><text display-inline="yes-display-inline">Section 1701 of title 38, United States Code, is amended by adding at the end the following new paragraphs:</text>
<quoted-block display-inline="no-display-inline" id="H5CC5FAAE83A94BCFB9C031E73DBC861D" style="USC">
<paragraph id="H0B058312872A446AB3A91549F8089931"><enum>(11)</enum><text display-inline="yes-display-inline">The term <term>network provider</term> means any of the following health care providers that have entered into a contract or agreement under which the provider agrees to furnish care and services to eligible veterans under section 1703A of this title:</text>
<subparagraph id="H94181C131B6547968261EC4F56348B7C"><enum>(A)</enum><text>Any health care provider or supplier that is participating in the Medicare Program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.), including any physician furnishing services under such program.</text>
</subparagraph><subparagraph id="HC84F1F8088AA4435A362A0FC113963BE"><enum>(B)</enum><text display-inline="yes-display-inline">Any provider of items and services receiving payment under a State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) or a waiver of such a plan.</text>
</subparagraph><subparagraph id="H55CEDFC5C23B44A4B1B59EE4853D187E"><enum>(C)</enum><text>Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>)).</text>
</subparagraph><subparagraph id="H74221778ED0C48F88D9A8CBD35BF6920"><enum>(D)</enum><text>The Department of Defense.</text> </subparagraph><subparagraph id="H3F6435551E4241588C699DC3B26F7BF7"><enum>(E)</enum><text>The Indian Health Service.</text>
</subparagraph><subparagraph id="HFBBD5B38F07545D1AB2C5DC5C0AE55D4"><enum>(F)</enum><text>Any health care provider that is an academic affiliate of the Department.</text> </subparagraph><subparagraph id="HE501E6D3C08B403C9C7990D7A883BA00"><enum>(G)</enum><text>Any health care provider not otherwise covered under any of subparagraphs (A) through (F) that meets criteria established by the Secretary for purposes of such section.</text>
</subparagraph></paragraph><paragraph commented="no" id="HF04DA3C8D4034EAB9E314DE44D7ADD3D"><enum>(12)</enum><text display-inline="yes-display-inline">The term <term>VA Care in the Community Program</term> means the program under which the Secretary furnishes hospital care or medical services to veterans through network providers pursuant to section 1703A of this title.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HF3CCC7E9115E48008C880480F856DD5C"><enum>(d)</enum><header>Transition of provision of care</header><text>This Act, and the amendments made by this Act, may not be construed to affect the obligations of the Secretary of Veterans Affairs under contracts and agreements for the provision of hospital care, medical services, and extended care services entered into before the date of the enactment of this Act at the terms and rates contained in such contracts and agreements.</text>
</subsection></section><section display-inline="no-display-inline" id="H6B68771390B349DFBAA93AFF38E40ACF" section-type="subsequent-section"><enum>103.</enum><header>Veterans Care Agreements</header>
<subsection id="H62FA736C3CE740C1AE67077BE4222A98"><enum>(a)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, is further amended by inserting after section 1703A, as added by section 102, the following new section:</text>
<quoted-block display-inline="no-display-inline" id="H1A2BD06437D04581B22E07D71F4DABD5" style="USC">
<section id="HCE8C70B9412844A19D214F6ED7948F36"><enum>1703B.</enum><header>Veterans Care Agreements with non-network providers</header>
<subsection id="H09D8ED61E1E6437AA014944718A8A4CB"><enum>(a)</enum><header>Veterans Care Agreements</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HF2D34BCEE79E45C58921173145D3E331"><enum>(1)</enum><text display-inline="yes-display-inline">In addition to furnishing hospital care, medical services, or extended care services under this chapter at facilities of the Department or under contracts or agreements entered into pursuant to section 1703A of this title or any other provision of law other than this section, the Secretary may furnish such care and services to eligible veterans through the use of agreements, to be known as <quote>Veterans Care Agreements</quote>, entered into under this section by the Secretary with eligible non-network providers.</text>
</paragraph><paragraph id="HC78548BC48394932A2FEAAE2B81F228A" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">The Secretary may enter into a Veterans Care Agreement under this section with an eligible non-network provider if the Secretary determines that—</text>
<subparagraph id="H3896F856F6D84510ADFB82154B9098CF"><enum>(A)</enum><text>the provision of the hospital care, medical services, or extended care services at a Department facility 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; and</text>
</subparagraph><subparagraph id="HA33A37822DFE48D2A9185CF465FFC303"><enum>(B)</enum><text>such care or services are not available to be furnished by a non-Department health care provider under a contract or agreement entered into pursuant to a provision of law other than this section.</text>
</subparagraph></paragraph><paragraph display-inline="no-display-inline" id="HA73DE878BA9C4835930C69E1880E5877" indent="up1"><enum>(3)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H5613A719FE414E66B63AB515D10E7BDC"><enum>(A)</enum><text display-inline="yes-display-inline">In accordance with subparagraphs (C) and (D), the Secretary shall review each Veterans Care Agreement with a non-network provider to determine whether it is practical or advisable to, instead of carrying out such agreement—</text>
<clause id="HF942D6D4888B4F0C915FF0147F5E6E28" indent="up1"><enum>(i)</enum><text display-inline="yes-display-inline">provide at a Department facility the hospital care, medical services, or extended care services covered by such agreement; or</text>
</clause><clause id="HA590F5E55AD545E09A051EF38851F7FB" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">enter into an agreement with the provider under section 1703A of this title to provide such care or services.</text>
</clause></subparagraph><subparagraph commented="no" id="H52C211750E6546589AD078B916D3CE0B" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">If the Secretary determines pursuant to a review of a Veterans Care Agreement under subparagraph (A) that it is practical or advisable to provide hospital care, medical services, or extended care services at a Department facility, or enter into an agreement under section 1703A of this title to provide such care or services, as the case may be, the Secretary—</text>
<clause commented="no" id="H1B6B4985CC2C43039A104EC5CB133D54"><enum>(i)</enum><text>may not renew the Veterans Care Agreement; and</text> </clause><clause commented="no" id="HE167D978FAE4488C88F7E977D6E37B29"><enum>(ii)</enum><text>shall take such actions as are necessary to implement such determination.</text>
</clause></subparagraph><subparagraph id="H55F2E0163D764490A81094FBA793E8A6" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">This paragraph shall apply with respect to Veterans Care Agreements entered into with a non-network provider whose gross annual revenue, as determined under subsection (b)(1), exceeds—</text>
<clause id="HAAB12C3B281F45118946D28A76592CDD"><enum>(i)</enum><text display-inline="yes-display-inline">$3,000,000, in the case of a provider that furnishes homemaker or home health aide services; or</text> </clause><clause id="HEB9AF63B11DE4E018204A822DDA79206"><enum>(ii)</enum><text>$1,000,000, in the case of any other provider.</text>
</clause></subparagraph><subparagraph id="H95F911E44FD941E3AC91AAE940A7B4F5" indent="up1"><enum>(D)</enum><text display-inline="yes-display-inline">The Secretary shall conduct each review of a Veterans Care Agreement under subparagraph (A) as follows:</text>
<clause id="H16F6C977274541C293DEC9053541D340"><enum>(i)</enum><text>Once during the 18-month period beginning on the date that is six months after date on which the agreement is entered into.</text>
</clause><clause id="H7370197B800A4842B8B05926E84679F3"><enum>(ii)</enum><text>Not less than once during each four-year period beginning on the date on which the review under subparagraph (A) is conducted.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H2EE659E6C0F1499B8DF7BC8A843FCFCA"><enum>(b)</enum><header>Eligible non-Network providers</header><text display-inline="yes-display-inline">A provider of hospital care, medical services, or extended care services is eligible to enter into a Veterans Care Agreement under this section if the Secretary determines that the provider meets the following criteria:</text>
<paragraph commented="no" id="H072B942C6A214631B153EAAF120ACD87"><enum>(1)</enum><text display-inline="yes-display-inline">The gross annual revenue of the provider under contracts or agreements entered into with the Secretary in the year preceding the year in which the provider enters into the Veterans Care Agreement does not exceed—</text>
<subparagraph id="H1851CC3C2A8F4F249FBD650FF9C100B7"><enum>(A)</enum><text>$5,000,000 (as adjusted in a manner similar to amounts adjusted pursuant to section 5312 of this title), in the case of a provider that furnishes homemaker or home health aide services; or</text>
</subparagraph><subparagraph id="HEE87FAC2C94E4CBCAE8CEFB0257267CA"><enum>(B)</enum><text>$2,000,000 (as so adjusted), in the case of any other provider.</text> </subparagraph></paragraph><paragraph commented="no" id="H3A8180FA1C45437C86E34230CDD62DE3"><enum>(2)</enum><text display-inline="yes-display-inline">The provider is not a network provider and does not otherwise provide hospital care, medical services, or extended care services to patients pursuant to a contract entered into with the Department.</text>
</paragraph><paragraph commented="no" id="H99D2C8D5175D4F438B970F9A701CE303"><enum>(3)</enum><text>The provider is—</text> <subparagraph commented="no" id="H12411BD854164FD8A567C0EBBFFEA549"><enum>(A)</enum><text>a provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)</external-xref>);</text>
</subparagraph><subparagraph commented="no" id="H08D3C0C5733D4C3B8A19BEBF23DFD6F8"><enum>(B)</enum><text>a physician or supplier that has enrolled and entered into a participation agreement under section 1842(h) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u(h)</external-xref>);</text>
</subparagraph><subparagraph commented="no" id="H68214605AF86456CB671D3B3B7766059"><enum>(C)</enum><text>a provider of items and services receiving payment under a State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) or a waiver of such a plan;</text>
</subparagraph><subparagraph commented="no" id="H0BBC746622E1406E906599229B15651F"><enum>(D)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/3002">42 U.S.C. 3002</external-xref>)); or</text>
</subparagraph><subparagraph commented="no" id="HDEB9617E21F8458DA7B937F4B393B043"><enum>(E)</enum><text>a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (<external-xref legal-doc="usc" parsable-cite="usc/29/796a">29 U.S.C. 796a</external-xref>)).</text>
</subparagraph></paragraph><paragraph id="HFFE235AD91E941DF9B94CC1217D0F263"><enum>(4)</enum><text>The provider is certified pursuant to the process established under subsection (c)(1).</text> </paragraph><paragraph commented="no" id="HEC195EAFEE5449669A2772F42BCDF2C1"><enum>(5)</enum><text>Any additional criteria determined appropriate by the Secretary.</text>
</paragraph></subsection><subsection commented="no" id="H25A1634339114C5BA35667510C487866"><enum>(c)</enum><header>Provider certification</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H44160657886F42F4A11372394E361C82"><enum>(1)</enum><text>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:</text>
<subparagraph commented="no" id="H4F79D7C78AFA4FB6A424D5EBB2E0EE95" indent="up1"><enum>(A)</enum><text>Procedures for the submission of applications for certification and deadlines for actions taken by the Secretary with respect to such applications.</text>
</subparagraph><subparagraph commented="no" id="H0A7317FA648D4930A81103F8774C5723" indent="up1"><enum>(B)</enum><text>Standards and procedures for the approval and denial of certifications and the revocation of certifications.</text>
</subparagraph><subparagraph commented="no" id="HDA22A154EC3445B1A594AFD218F385AD" indent="up1"><enum>(C)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395(j)(2)(B)</external-xref>) and the standards set forth under section 9.104 of title 48, Code of Federal Regulations, or any successor regulation.</text>
</subparagraph><subparagraph commented="no" id="H9CBEDDBD784E4F6DA941824BF485E16D" indent="up1"><enum>(D)</enum><text>Requirement for denial or revocation of certification if the Secretary determines that the otherwise eligible provider is—</text>
<clause commented="no" id="HD092C7F3AD29426C8ABA50F9B9F12BFD"><enum>(i)</enum><text>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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1320a-7">42 U.S.C. 1320a–7</external-xref> and 1320a–7a); or</text>
</clause><clause commented="no" id="H0DD08C3618ED4CA7AD4669A2F5180559"><enum>(ii)</enum><text>identified as an excluded source on the list maintained in the System for Award Management, or any successor system.</text>
</clause></subparagraph><subparagraph commented="no" id="H521B0AA1ED334BB0ADC2ED0F0C8A1A60" indent="up1"><enum>(E)</enum><text>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.</text>
</subparagraph></paragraph><paragraph commented="no" id="H557B897FC0BD40FCB6C74FB4A337C178" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">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 (b)(4).</text>
</paragraph></subsection><subsection id="H1906EA4F184A4A6A91B319AFC13987DC"><enum>(d)</enum><header>Terms of Agreements</header><text display-inline="yes-display-inline">Subsections (d), (e), (f), and (g) of section 1703A of this title shall apply with respect to a Veterans Care Agreement in the same manner such subsections apply to contracts and agreements entered into under such section.</text>
</subsection><subsection id="HCAA0E2316AEB4273BB650A25085E348D"><enum>(e)</enum><header>Exclusion of certain Federal contracting provisions</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HB4099250A2C74A2BB3EAF9367CBF24D6"><enum>(1)</enum><text display-inline="yes-display-inline">Notwithstanding any other provision of law, the Secretary may enter into a Veterans Care Agreement using procedures other than competitive procedures.</text>
</paragraph><paragraph id="HF3C6975A37714F2997BA328FE63C7A11" indent="up1"><enum>(2)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="HD3FA86B5FFA44ADAA57A15860C656118"><enum>(A)</enum><text display-inline="yes-display-inline">Except as provided in subparagraph (B) and unless otherwise provided in this section, an eligible non-network 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 (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) or the Medicaid program under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) are not subject to.</text>
</subparagraph><subparagraph commented="no" id="H661AD8EB5B5F43DAB5B8A878AA3C98D7" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">In addition to the provisions of laws covered by subparagraph (A), an eligible non-network provider shall be subject to the following provisions of law:</text>
<clause commented="no" id="H4D0C2A7A505949B0874083B343893213"><enum>(i)</enum><text>Any applicable law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties.</text>
</clause><clause id="H17386916F28F44BDBAD18F8DAD86EB5E"><enum>(ii)</enum><text>Section 1352 of title 31, except for the filing requirements under subsection (b) of such section.</text> </clause><clause commented="no" id="HEF237367A0CC430595DE3C0DB451542B"><enum>(iii)</enum><text display-inline="yes-display-inline">Section 4705 or 4712 of title 41, and any other applicable law regarding the protection of whistleblowers.</text>
</clause><clause id="HE03AFD70F69C4C63891ABAC6B95B99E7"><enum>(iv)</enum><text>Section 4706(d) of title 41.</text> </clause><clause commented="no" id="H42C67F2226304BAF9CCE06FB1CC4646A"><enum>(v)</enum><text display-inline="yes-display-inline">Title VII of the Civil Rights Act of 1964 (<external-xref legal-doc="usc" parsable-cite="usc/42/2000e">42 U.S.C. 2000e</external-xref> et seq.) to the same extent as such title applies with respect to the eligible non-network provider in providing care or services through an agreement or arrangement other than under a Veterans Care Agreement.</text>
</clause></subparagraph></paragraph></subsection><subsection id="H786E20665ADE4F35A677A901E454945A"><enum>(f)</enum><header>Termination of a Veterans Care agreement</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HFF9C93F3BBCE4DF4A459BD599087D596"><enum>(1)</enum><text display-inline="yes-display-inline">An eligible non-network 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.</text>
</paragraph><paragraph id="H4661D3C396FA4E6BAE09C3F1879017F4" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">The Secretary may terminate a Veterans Care Agreement with an eligible non-network provider under this section at such time and upon such notice to the provider as the Secretary may specify for the purposes of this section, if the Secretary determines necessary.</text>
</paragraph></subsection><subsection id="H00D13B49D70A416785CBBFA949917F12"><enum>(g)</enum><header>Disputes</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HD0E464798F5A4F4EB3C25F9EF3750CA3"><enum>(1)</enum><text display-inline="yes-display-inline">The Secretary shall establish administrative procedures for providers with which the Secretary has entered into a Veterans Care Agreement to present any dispute arising under or related to the agreement.</text>
</paragraph><paragraph id="H676376E0824240C1B9CC3245B7D6F0BD" indent="up1"><enum>(2)</enum><text display-inline="yes-display-inline">Before using any dispute resolution mechanism under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/41/71">chapter 71</external-xref> of title 41 with respect to a dispute arising under a Veterans Care Agreement under this section, a provider must first exhaust the administrative procedures established by the Secretary under paragraph (1).</text>
</paragraph></subsection><subsection commented="no" id="HA6C2D2C062C340D5AA72B6D3AE8C1401"><enum>(h)</enum><header>Authority To pay for other authorized services</header>
<paragraph commented="no" display-inline="yes-display-inline" id="H2218F5AEEB8B48EDB4AC46E0E389DCC1"><enum>(1)</enum><text display-inline="yes-display-inline">If, in the course of an episode of care for which hospital care, medical services, or extended care services are furnished to an eligible veteran pursuant to a Veterans Care Agreement, any part of such care or services is furnished by a medical provider who is not an eligible non-network provider or a network provider, the Secretary may compensate such provider for furnishing such care or services.</text>
</paragraph><paragraph commented="no" id="H95877E8676C8433FBF9A83D1A3A4BE97" indent="up1"><enum>(2)</enum><text>The Secretary shall make reasonable efforts to enter into a Veterans Care Agreement with any provider who is compensated pursuant to paragraph (1).</text>
</paragraph></subsection><subsection id="H00EC495B64C74D1081812FF38C0A49C3"><enum>(i)</enum><header>Annual reports</header>
<paragraph commented="no" display-inline="yes-display-inline" id="HBBE1D7FF0C28403EAD9589BDDF39B29A"><enum>(1)</enum><text>Not later than December 31 of the year following the fiscal year in which the Secretary first enters into a Veterans Care Agreement under this section, and each year thereafter, the Secretary shall submit to the appropriate congressional committees an annual report that includes a list of all Veterans Care Agreements entered into as of the date of the report.</text>
</paragraph><paragraph id="H6F54BF85C6274641BB453BA44C9A2CC7" indent="up1"><enum>(2)</enum><text>The requirement to submit a report under paragraph (1) shall terminate on the date that is five years after the date of the enactment of this section.</text>
</paragraph></subsection><subsection id="H234ED231D9C84A4BBB71843F8CDF0EE5"><enum>(j)</enum><header>Quality of care</header><text display-inline="yes-display-inline">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 or other quality of care standards, as determined by the Secretary.</text>
</subsection><subsection id="H441694B19D254EBD84F242DCFE1F95B6"><enum>(k)</enum><header>Delegation</header><text display-inline="yes-display-inline">The Secretary may delegate the authority to enter into or terminate a Veterans Care Agreement to an official of the Department at a level not below the Director of a Veterans Integrated Service Network or the Director of a Network Contracting Office.</text>
</subsection><subsection commented="no" id="H0926211E1FD9416DB2757B0F32A125E0"><enum>(l)</enum><header>Definitions</header><text>In this section:</text> <paragraph commented="no" id="H5E87BC0D649243429BE541FD0E46D5E2"><enum>(1)</enum><text>The term <term>appropriate congressional committees</term> means—</text>
<subparagraph commented="no" id="H25430ED7DFFE4B328DD47FBBA9E15C34"><enum>(A)</enum><text>the Committees on Veterans’ Affairs of the House of Representatives and the Senate; and</text> </subparagraph><subparagraph commented="no" id="HC4A0A280662B4EAEAEBF920F7470C8F2"><enum>(B)</enum><text>the Committees on Appropriations of the House of Representatives and the Senate.</text>
</subparagraph></paragraph><paragraph id="H115FE87753D74573B8FECE2CF223F7CD"><enum>(2)</enum><text>The term <term>eligible veteran</term> has the meaning given such term in section 1703A(m) of this title.</text> </paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </subsection><subsection id="HCE5475671A67417BADAAFA0D042F5213"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1703A, as added by section 102, the following new item:</text>
<quoted-block display-inline="no-display-inline" id="H5A2FF49BAE9D4AA08CE6B24A862FEB84" style="OLC">
<toc regeneration="no-regeneration">
<toc-entry level="section">1703B. Veterans Care Agreements with non-network providers.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section display-inline="no-display-inline" id="H2E40BF4378D9475689B1737DEE13A825" section-type="subsequent-section"><enum>104.</enum><header>Modification of authority to enter into agreements with State homes to provide nursing home care</header>
<subsection id="H7C67FB9EB4A149D7808AD23108C67BA5"><enum>(a)</enum><header>Use of agreements</header>
<paragraph id="HAFB7F76DE0B44E75B588B0685BE4109D"><enum>(1)</enum><header>In general</header><text>Paragraph (1) of section 1745(a) of title 38, United States Code, is amended, in the matter preceding subparagraph (A), by striking <quote>a contract (or agreement under section 1720(c)(1) of this title)</quote> and inserting <quote>an agreement</quote>.</text>
</paragraph><paragraph id="HF00322532F3D4BBAA9CC1358865CD5C8"><enum>(2)</enum><header>Payment</header><text>Paragraph (2) of such section is amended by striking <quote>contract (or agreement)</quote> each place it appears and inserting <quote>agreement</quote>.</text> </paragraph></subsection><subsection id="HFB8E851E32E449FF9624674E22C97406"><enum>(b)</enum><header>Treatment of certain laws</header><text>Such section is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H28298F63EF6946FBAAB99C996137171E" style="OLC">
<paragraph id="HEA741A56569546C0B02A1AF483905C5A" indent="up1"><enum>(4)</enum>
<subparagraph commented="no" display-inline="yes-display-inline" id="H6E19F713E8F6458A999193EAC05B6929"><enum>(A)</enum><text>An agreement under this section may be entered into without regard to any law that would require the Secretary to use competitive procedures in selecting the party with which to enter into the agreement.</text>
</subparagraph><subparagraph id="H2507D980D6584D948035FF7AB4F04329" indent="up1"><enum>(B)</enum>
<clause commented="no" display-inline="yes-display-inline" id="H7C2EE8D5521F417DAA6BAE57672AD16D"><enum>(i)</enum><text>Except as provided in clause (ii) and unless otherwise provided in this section or in regulations prescribed pursuant to this section, a State home that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers are not subject under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395</external-xref> et seq.) or the Medicaid program under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.).</text>
</clause><clause id="H57B048300F4A413980FEA255F79945D7" indent="up1"><enum>(ii)</enum><text>The exclusion under clause (i) does not apply to laws regarding integrity, ethics, fraud, or that subject a person to civil or criminal penalties.</text>
</clause></subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="H7BE00072E5A84A6FA1CCEC25F94C1E55" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">Title VII of the Civil Rights Act of 1964 (<external-xref legal-doc="usc" parsable-cite="usc/42/2000e">42 U.S.C. 2000e</external-xref> et seq.) shall apply with respect to a State home that enters into an agreement under this section to the same extent as such title applies with respect to the State home in providing care or services through an agreement or arrangement other than under this section.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HEBA4EA8D836345A68CB80D22D231EF0F"><enum>(c)</enum><header>Effective date</header>
<paragraph id="HBEF699A6F2B743C0AE4EA42ECC9952A8"><enum>(1)</enum><header>In general</header><text>The amendments made by this section shall apply to agreements entered into under section 1745 of such title on and after the date on which the regulations prescribed by the Secretary of Veterans Affairs to implement such amendments take effect.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H5A1810158AAD475CB8352534486AB3E4"><enum>(2)</enum><header>Publication</header><text>The Secretary shall publish the date described in paragraph (1) in the Federal Register not later than 30 days before such date.</text>
</paragraph></subsection></section><section commented="no" id="H5F30FE8705C8454B99AC3AB195C5ADF1"><enum>105.</enum><header>Department of Veterans Affairs electronic interface for processing of medical claims</header>
<subsection id="H482C812837C34AC687803CF2BE355F55"><enum>(a)</enum><header>Electronic interface</header><text>Not later than the implementation date specified in section 108(a), the Chief Information Officer of the Department of Veterans Affairs shall ensure that the information technology system used by the Department to receive, process, and pay claims under the VA Care in the Community Program established in section 1703A of title 38, United States Code, as added by section 102, and under Veterans Care Agreements established in section 1703B of such title, as added by section 103, includes the following:</text>
<paragraph id="HC42EAD3E3B7E4432A11B6361EF7585E5"><enum>(1)</enum><text>A function through which a covered non-Department health care provider may submit all required data and supporting information required for claims reimbursement through electronic data interchanges.</text>
</paragraph><paragraph id="H20C6BC9D1CF84363B231FECDD6D0191D"><enum>(2)</enum><text>An ability to automatically adjudicate claims.</text> </paragraph><paragraph id="H87C3AC4B3B3147FCB6197476F086CAE5"><enum>(3)</enum><text>A centralized claims database that is accessible nationwide.</text>
</paragraph><paragraph id="H502034D173F240928799462D0D7AFFF3"><enum>(4)</enum><text>Integration with the relevant eligibility and authorization information technology systems of the Department.</text>
</paragraph><paragraph id="H6BC0FAB539124297812CA2CC6A5D5570"><enum>(5)</enum><text display-inline="yes-display-inline">Ability for a covered non-Department health care provider to ascertain the status of a pending claim submitted by the provider, receive information regarding missing documentation or discrepancies that may impede claim processing timelines or result in rejection, and receive notification when such claim is accepted for reimbursement or rejected.</text>
</paragraph><paragraph id="H642D552B006C44C28F09501AF8EA0AF1"><enum>(6)</enum><text display-inline="yes-display-inline">A claim review system similar to that used by the Centers for Medicare & Medicaid Services, as of the date of the enactment of this Act, to determine the appropriateness and accuracy of payments to providers and to ensure program integrity and oversight.</text>
</paragraph></subsection><subsection id="HEEFFC35F9CFC4C65B64091FA2F52EDF6"><enum>(b)</enum><header>Security and privacy</header><text>The Chief Information Officer shall also ensure that the information technology system covered under subsection (a) meets the following criteria:</text>
<paragraph id="H359B42A375B94419AF74376FC4A996AE"><enum>(1)</enum><text display-inline="yes-display-inline">Such system shall be developed and implemented in compliance with all applicable laws, regulations and Federal Government standards regarding information security, privacy, and accessibility.</text>
</paragraph><paragraph id="HE8436601F1B0415E967CBABF402C4CCB"><enum>(2)</enum><text>Such system shall provide for the elicitation, analysis, and prioritization of functional and nonfunctional information security and privacy requirements for such system, including security and privacy services and architectural requirements relating to security and privacy based on a thorough risk assessment of all reasonably anticipated cyber and noncyber threats to the security and privacy of electronic protected health information made available through such interface.</text>
</paragraph><paragraph id="HB3063A775FCA4A019AC3BAF55284C127"><enum>(3)</enum><text>Such system shall provide for the elicitation, analysis, and prioritization of secure development requirements relating to such system.</text>
</paragraph><paragraph id="HA38DEF9AC51B4A968BA123CB3B5D154B"><enum>(4)</enum><text>Such system shall provide assurance that the prioritized information security and privacy requirements of such system—</text>
<subparagraph id="H6E6D217BFF774861A30A175E0ED840C8"><enum>(A)</enum><text>are correctly implemented in the design and implementation of such system through the systems development lifecycle; and</text>
</subparagraph><subparagraph id="HCF11845145A64CDB9BAA3F281956D7A0"><enum>(B)</enum><text>satisfy the information objectives of such system relating to security and privacy throughout the systems development lifecycle.</text>
</subparagraph></paragraph></subsection><subsection id="HE3993DD515FD4286AEF825E8B96F6EFB"><enum>(c)</enum><header>Contract authority</header><text>The Chief Information Officer may enter into a contract for purposes of carrying out this section.</text> </subsection><subsection commented="no" id="HE0C72CF9D7574651BC0BFDC974F6451A"><enum>(d)</enum><header>Definitions</header><text>In this section:</text>
<paragraph commented="no" id="HFEC7CCA72AB64AF88D6E7667292DEC46"><enum>(1)</enum><text>The term <term>electronic protected health information</term> has the meaning given that term in section 160.103 of title 45, Code of Federal Regulations, as in effect on the date of the enactment of this Act.</text>
</paragraph><paragraph commented="no" id="H85CE45AF53244F74B4C5F50EE79D2982"><enum>(2)</enum><text display-inline="yes-display-inline">The term <term>covered non-Department health care provider</term> means—</text> <subparagraph commented="no" id="HE4A24E8759CB4949904A26950E523D7D"><enum>(A)</enum><text>a network provider (as defined by section 1701(11) of title 38, United States Code, as added by section 102);</text>
</subparagraph><subparagraph id="H571307922D064D4789D8C6F2E2627A12"><enum>(B)</enum><text>a non-network provider with which the Secretary has entered into a Veterans Care Agreement under section 1703B of such title, as added by section 103; or</text>
</subparagraph><subparagraph commented="no" id="H09C55063BAA64AD7A244EB8532C4AB4F"><enum>(C)</enum><text display-inline="yes-display-inline">any other non-Department eligible provider or non-Department health care provider that furnishes hospital care or medical services pursuant to chapter 17 of such title.</text>
</subparagraph></paragraph><paragraph commented="no" id="HC6C160BC44044E15B5E410763D748C47"><enum>(3)</enum><text display-inline="yes-display-inline">The term <term>secure development requirements</term> means, with respect to the information technology system established under subsection (a), activities that are required to be completed during the system development lifecycle of such interface, such as secure coding principles and test methodologies.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H127FEE5A1FE04DA39BAA3FF0B48AC5FE"><enum>(4)</enum><text>The term <term>VA Care in the Community Program</term> has the meaning given that term in section 1701(12) of title 38, United States Code, as added by section 102.</text>
</paragraph></subsection></section><section commented="no" id="H6473F6656C3143E99F333664764AC4C5"><enum>106.</enum><header>Funding for VA Care in the Community Program</header>
<subsection commented="no" id="H36C3D56207934E3FA286D35CB365F6DC"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">All amounts required to carry out the VA Care in the Community Program and Veterans Care Agreements under section 1703B of title 38, United States Code, shall be derived from the Veterans Health Administration, Medical Community Care account.</text>
</subsection><subsection commented="no" id="H28798C3A622E42ADB4AB677935638CE2"><enum>(b)</enum><header>Transfer of amounts</header>
<paragraph commented="no" id="HE5AF4F7AD3AC43569ACE432973A510ED"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Any unobligated amounts in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) shall be transferred to the Veterans Health Administration, Medical Community Care account on the later of the following dates:</text>
<subparagraph commented="no" id="HE6F462A9FCFD43359E2FD43A18985B4E"><enum>(A)</enum><text>The date that is one year after the date of the enactment of this Act.</text> </subparagraph><subparagraph commented="no" id="H58D6ECC17ED74B0EB72545215DD858D9"><enum>(B)</enum><text>The date on which the Secretary of Veterans Affairs submits to the Committees on Veterans’ Affairs of the Senate and the House of Representatives the certification required by section 107(c).</text>
</subparagraph></paragraph><paragraph commented="no" id="H32D6E45002F649F197944F1851C1D55A"><enum>(2)</enum><header>Conforming repeal</header>
<subparagraph commented="no" id="H255B7192E7A74C35906DC473E6A0C9F4"><enum>(A)</enum><header>In general</header><text>Effective immediately following the transfer of amounts under paragraph (1), section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is repealed.</text>
</subparagraph><subparagraph commented="no" id="H6A9BFB3BE222475C809C7F2239C9ADB0"><enum>(B)</enum><header>Conforming amendment</header><text display-inline="yes-display-inline">Section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (<external-xref legal-doc="public-law" parsable-cite="pl/114/41">Public Law 114–41</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is amended by striking <quote>for non-Department provider programs (as defined in section 2(d))</quote> and all that follows through <quote>1802)</quote> and inserting the following: <quote>for the VA Care in the Community Program (as defined in section 1701(12) of title 38, United States Code) and Veterans Care Agreements under section 1703B of title 38, United States Code</quote>.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="H3AB692476B9B41DCAC148F55E32A89EF"><enum>(c)</enum><header>VA Care in the Community Program defined</header><text display-inline="yes-display-inline">In this section, the term <term>VA Care in the Community Program</term> has the meaning given that term in section 1701(12) of title 38, United States Code, as added by section 102.</text>
</subsection></section><section id="H6074EBB75F694C96B83F4214C07C154E"><enum>107.</enum><header>Termination of certain provisions authorizing medical care to veterans through non-Department of
Veterans Affairs providers</header>
<subsection id="HE549DA5B24154658A238750F7B0C9D11"><enum>(a)</enum><header>Termination of authority To contract for care in non-Department facilities</header>
<paragraph id="H0CF81D3E9FA74CAC8A494D2C4BA0A712"><enum>(1)</enum><header>In general</header><text>Section 1703 of title 38, United States Code, is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H82693ECB32C24E65AE88E6FB7EBE3057" style="OLC">
<subsection commented="no" id="H37674393669E4E55B37175A0ED744823"><enum>(e)</enum><text display-inline="yes-display-inline">The authority of the Secretary to carry out this section terminates on the date on which the Secretary certifies to the Committees on Veterans’ Affairs of the House of Representatives and the Senate that the Secretary is fully implementing section 1703A of this title.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="HFB850E59D8E749449B53F8A230CE55B1"><enum>(2)</enum><header>Conforming amendments</header>
<subparagraph id="H2F7DB9D228064F278BF4118362036667"><enum>(A)</enum><header>Dental care</header><text>Section 1712(a) of such title is amended—</text> <clause id="H5E6B44CFFCFB4ACAA1453D5AF89E1DA7"><enum>(i)</enum><text>in paragraph (3), by striking <quote>under clause (1), (2), or (5) of section 1703(a) of this title</quote> and inserting <quote>under the VA Care in the Community Program</quote>; and</text>
</clause><clause id="H266DDC47F43D4986B26319F09470E10A"><enum>(ii)</enum><text>in paragraph (4)(A), in the first sentence—</text> <subclause id="HF38FBFCBBCC04BEDA37C5616601AE94D"><enum>(I)</enum><text>by striking <quote>and section 1703 of this title</quote> and inserting <quote>and the VA Care in the Community Program (with respect to such a year beginning on or after the date on which the Secretary commences implementation of the VA Care in the Community Program)</quote>; and</text>
</subclause><subclause id="H92F7BF10DA984F90B32BD4801B8C5E65"><enum>(II)</enum><text>by striking <quote>in section 1703 of this title</quote> and inserting <quote>under the VA Care in the Community Program</quote>.</text> </subclause></clause></subparagraph><subparagraph id="H13B69DB3A4E5466F9F1E2AFB695D549F"><enum>(B)</enum><header>Readjustment counseling</header><text>Section 1712A(e)(1) of such title is amended by striking <quote>(under sections 1703(a)(2) and 1710(a)(1)(B) of this title)</quote> and inserting <quote>(under the VA Care in the Community Program)</quote>.</text>
</subparagraph><subparagraph id="HDCD7F44B73EC489FAB07E08BC7E4ACAD"><enum>(C)</enum><header>Death in Department facility</header><text>Section 2303(a)(2)(B)(i) of such title is amended by striking <quote>in accordance with section 1703 of this title</quote> and inserting <quote>under the VA Care in the Community Program</quote>.</text> </subparagraph><subparagraph id="HA9FFDC1A45F448CBA9278A6D89A64445"><enum>(D)</enum><header>Medicare provider agreements</header><text>Section 1866(a)(1)(L) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)(1)(L)</external-xref>) is amended—</text>
<clause id="H61B448863C064C4D82550EF50A759CF0"><enum>(i)</enum><text>by striking <quote>under section 1703 of title 38</quote> and inserting <quote>under the VA Care in the Community Program (as defined in section 1701(12) of title 38, United States Code)</quote>; and</text>
</clause><clause id="H1F869905699F4AD39922B7A8369929DE"><enum>(ii)</enum><text>by striking <quote>such section</quote> and inserting <quote>such program</quote>.</text> </clause></subparagraph></paragraph></subsection><subsection id="H43DA271AC3AC4F34B983DCC1356114E5"><enum>(b)</enum><header>Repeal of authority To contract for scarce medical specialists</header> <paragraph id="H8C00FF7C723743669B45A9CD7C984B61"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 7409 of title 38, United States Code, is repealed.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H7E643902E9D947B0B0E0F8DC56074998"><enum>(2)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 74 of such title is amended by striking the item relating to section 7409.</text>
</paragraph></subsection><subsection id="HD99826E5BD464C769DB1BE985BA3EB63"><enum>(c)</enum><header>Effective date</header><text>The amendments made by subsections (a) and (b) shall take effect on the date on which the Secretary certifies to the Committees on Veterans’ Affairs of the House of Representatives and the Senate that the Secretary is fully implementing section 1703A of title 38, United States Code, as added by section 102.</text>
</subsection></section><section id="H2F899B2DC2514A3D97D90D3008A565D8"><enum>108.</enum><header>Implementation and transition</header>
<subsection commented="no" id="H9FC3EC8F33E4403E9253B56B2E90F1B5"><enum>(a)</enum><header>Implementation</header><text display-inline="yes-display-inline">The Secretary of Veterans Affairs shall commence the implementation of section 1703A of title 38, United States Code, as added by section 102, and section 1703B of such title, as added by section 103, and shall make the transfer under section 106(b), by not later than one year after the date of the enactment of this Act. The Secretary shall prescribe interim final regulations to implement such sections and publish such regulations in the Federal Register.</text>
</subsection><subsection id="H8DC50F13410742B6A0C6F490060C6550"><enum>(b)</enum><header>Training</header><text display-inline="yes-display-inline">Before commencing the implementation of sections 1703A and 1703B of title 38, United States Code, as added by sections 102 and 103, respectively, the Secretary of Veterans Affairs shall—</text>
<paragraph id="H35D55A94A47C4C068DCFD0C52C3CD671"><enum>(1)</enum><text>certify to the Committees on Veterans’ Affairs of the House of Representatives and the Senate that—</text> <subparagraph id="HAEE3304ADC2F41F880A07A042B75B2A8"><enum>(A)</enum><text>each network provider (as defined by section 1701(11) of title 38, United States Code) and eligible non-network provider that furnishes care or services under such section 1703A or section 1703B is trained to furnish such care or services under such sections; and</text>
</subparagraph><subparagraph id="H293871F735B8496E9616FF7D2804FB4B"><enum>(B)</enum><text>each employee of the Department that refers, authorizes, or coordinates such care or services is trained to carry out such sections; and</text>
</subparagraph></paragraph><paragraph id="H7476659AA529452C8E4F87C8B29C1CAD"><enum>(2)</enum><text>establish standard, written guidance for network providers, non-Department health care providers, and any non-Department administrative entities acting on behalf of such providers, with respect to the policies and procedures for furnishing care or services under such sections.</text>
</paragraph></subsection></section><enum>II</enum><header>Other administrative matters</header>
<section id="HD0C05E4F8D1B49C4A564B839D35251AC" section-type="subsequent-section"><enum>201.</enum><header>Reimbursement for emergency ambulance services</header>
<subsection id="H141290117D4A44BBB6E82373A70A990B"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1725(c) of title 38, United States Code, is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H162918A9453D4F4690518208A45162E2" style="USC">
<paragraph id="HEEEC2AFF8A924CE6A25BBAFFC48E77F2" indent="up1"><enum>(5)</enum><text display-inline="yes-display-inline">In delineating the circumstances under which reimbursement may be made under this section for ambulance services for an individual, the Secretary shall treat such services as emergency services for which reimbursement may be made under this section if the Secretary determines that—</text>
<subparagraph id="HEBCF929794AC497BA46BCF082F2D52D3"><enum>(A)</enum><text>the request for ambulance services was made as a result of the sudden onset of a medical condition of such a nature that a prudent layperson who possesses an average knowledge of health and medicine—</text>
<clause id="HC0627B516C1143B282E917416EB96740"><enum>(i)</enum><text>would have reasonably expected that a delay in seeking immediate medical attention would have been hazardous to the life or health of the individual; or</text>
</clause><clause id="H563DB9F9EC0D44C885C34A93D764C939"><enum>(ii)</enum><text>could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, the serious impairment of bodily functions, or the serious dysfunction of any bodily organ or part; and</text>
</clause></subparagraph><subparagraph id="H80BF51F9B06F40DBB6A2D90B9BA9E2A9"><enum>(B)</enum><text>the individual is transported to the most appropriate medical facility capable of treating such medical condition.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection commented="no" id="H3CE87971DE744B758D5005265C051D6D"><enum>(b)</enum><header>Effective date</header><text>The amendment made by subsection (a) shall take effect on the date of the enactment of this Act and shall apply with respect to ambulance services provided on or after January 1, 2019.</text>
</subsection></section><section display-inline="no-display-inline" id="HD06397C37C294DF4897D1972DCD3F1B5" section-type="subsequent-section"><enum>202.</enum><header>Improvement of care coordination for veterans through exchange of certain medical records</header><text display-inline="no-display-inline">Section 7332(b) of title 38, United States Code, is amended—</text> <paragraph id="HC0733738EAA74515A2CEA3815902F848"><enum>(1)</enum><text>in paragraph (2), by adding at the end the following new subparagraphs:</text>
<quoted-block display-inline="no-display-inline" id="H7D4FDC6A353541C28C81DBB1A6B4AD47" style="OLC">
<subparagraph id="HF70DBCDA02C442DFAACEA654CAA7682C"><enum>(H)</enum><text display-inline="yes-display-inline">To a public or private health care provider in order to provide treatment or health care to a shared patient.</text>
</subparagraph><subparagraph id="H532422778D17468F9DBCDEC7FC17F656"><enum>(I)</enum><text display-inline="yes-display-inline">To a third party in order to recover or collect reasonable charges for care furnished to a veteran for a non-service-connected disability pursuant to section 1729 of this title or section 1 of <external-xref legal-doc="public-law" parsable-cite="pl/87/693">Public Law 87–693</external-xref> (<external-xref legal-doc="usc" parsable-cite="usc/42/2651">42 U.S.C. 2651</external-xref>).</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block>
</paragraph><paragraph id="HF927245457FF4C009315FEF9054BC394"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="H48270B85E9C946F6A197B2FFFBFE2AD1" style="USC"> <paragraph id="H717FB827257E4789B6862EED1AC326EB" indent="up1"><enum>(4)</enum><text display-inline="yes-display-inline">Nothing in this section shall be construed to authorize any provision of records in violation of relevant health record privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (<external-xref legal-doc="public-law" parsable-cite="pl/104/191">Public Law 104–191</external-xref>).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></section><section id="H8B091EC020684D50AEB512CD9A10FED2"><enum>203.</enum><header>Elimination of copayment offset</header>
<subsection id="HEC316EAC27D44526B608DB27129E4970"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1729(a) of title 38, United States Code, is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="HF8B4E87AB2974F429A23E6F3B45B21CA" style="USC">
<paragraph id="HF47DBF84D63F4CBC8FBFEA7FFA7C72CB"><enum>(4)</enum><text display-inline="yes-display-inline">Notwithstanding any other provision of law, any amount that the United States may collect or recover under this section shall not affect any copayment amount a veteran is otherwise obligated to pay under this chapter.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HF410897DF128452BAE3E6FBB6B0C373A"><enum>(b)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendment made by subsection (a) shall take effect on the date of the enactment of this Act and apply with respect to a copayment obligation that arises on or after the date of the enactment of this Act.</text>
</subsection></section><section id="H31F158EA36A444FB83BD88D04D5EB283"><enum>204.</enum><header>Use of Department of Veterans Affairs Medical Care Collections Fund for certain improvements in
collections</header><text display-inline="no-display-inline">Section 1729A(c)(1)(B) of title 38, United States Code, is amended by inserting <quote>(including with respect to automatic data processing or information technology improvements)</quote> after <quote>collection</quote>.</text> </section><section id="H304CDDC4A33A48A194767EBE71A6F8F7" section-type="subsequent-section"><enum>205.</enum><header>Department of Veterans Affairs health care productivity improvement</header> <subsection id="H39BF9409427A4DCEBBAC0D0E61C6D422"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, is further amended by inserting after section 1705A the following new section:</text>
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<section id="HCCF1C85DF43145E4B64BBD41CA13FD5A"><enum>1705B.</enum><header>Management of health care: productivity</header>
<subsection id="HA0A60EA8872B4181878C1733DE2246CB"><enum>(a)</enum><header>Relative value unit tracking</header><text display-inline="yes-display-inline">The Secretary shall track relative value units for all Department providers.</text> </subsection><subsection id="H8571F42CD3FE48DBAEA3BAA3F049279B"><enum>(b)</enum><header>Clinical procedure coding training</header><text>The Secretary shall require all Department providers to attend training on clinical procedure coding.</text>
</subsection><subsection id="H2FECD522215446EA9C18074BEB2FA53A"><enum>(c)</enum><header>Performance standards</header><text>The Secretary shall establish for each Department facility—</text> <paragraph id="H9D7751DECFB54B67A120788049E79EEA"><enum>(1)</enum><text>standardized performance standards based on nationally recognized relative value unit production standards applicable to each specific profession in order to evaluate clinical productivity at the provider and facility level;</text>
</paragraph><paragraph id="HE267FC27C45E4CC4BDBB605BE78C0883"><enum>(2)</enum><text>remediation plans to address low clinical productivity and clinical inefficiency; and</text> </paragraph><paragraph id="H85A8ECBE215E42A09F4E8FB0BA029D02"><enum>(3)</enum><text>an ongoing process to systematically review the content, implementation, and outcome of the plans developed under paragraph (2).</text>
</paragraph></subsection><subsection commented="no" id="H699802D9F6E749C6AF41817C3F9FED8D"><enum>(d)</enum><header>Definitions</header><text>In this section:</text> <paragraph commented="no" id="HDEE8EFDC31814CDC95459C3A2054918F"><enum>(1)</enum><text>The term <term>Department provider</term> means an employee of the Department whose primary responsibilities include furnishing hospital care or medical services, including a physician, a dentist, an optometrist, a podiatrist, a chiropractor, an advanced practice registered nurse, and a physician’s assistant acting as an independent provider.</text>
</paragraph><paragraph commented="no" id="H8ECABAAD9C2F465B8FAB511008AB4901"><enum>(2)</enum><text display-inline="yes-display-inline">The term <term>relative value unit</term> means a unit for measuring workload by determining the time, mental effort and judgment, technical skill, physical effort, and stress involved in delivering a procedure.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HE8A1DED5D1ED4E39A184B0FDF727CE35"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of such chapter is further amended by inserting after the item relating to section 1705A the following new item:</text>
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<toc regeneration="no-regeneration">
<toc-entry level="section">1705B. Management of health care: productivity.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H192212DCAC9E438C89C75F634180F846"><enum>(c)</enum><header>Report</header><text>Not later than one year after the date of the enactment of this Act, the Secretary shall submit to Congress a report on the implementation of section 1705B of title 38, United States Code, as added by subsection (a). Such report shall include, for each professional category of Department providers, the relative value unit of such category of providers at the national, Veterans Integrated Service Network, and facility levels.</text>
</subsection></section><section id="H68450AF9B8694263AC75DC78F8CE0218"><enum>206.</enum><header>Licensure of health care professionals of the Department of Veterans Affairs providing treatment
via telemedicine</header>
<subsection id="H3239D29DD4C142C79F78E2E916B4AC4B"><enum>(a)</enum><header>In general</header><text><external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">Chapter 17</external-xref> of title 38, United States Code, is further amended by inserting after section 1730A the following new section:</text>
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<section id="HBFE879A813BD458BAFA98BC1D5AF42A9"><enum>1730B.</enum><header>Licensure of health care professionals providing treatment via telemedicine</header>
<subsection id="H472C7E913FB14903A377B70831FD9D38"><enum>(a)</enum><header>In general</header><text>Notwithstanding any provision of law regarding the licensure of health care professionals, a covered health care professional may practice the health care profession of the health care professional at any location in any State, regardless of where the covered health care professional or the patient is located, if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter.</text>
</subsection><subsection id="HFFBE3E5EB5D0475AB74AD778B716C7B7"><enum>(b)</enum><header>Property of federal government</header><text>Subsection (a) shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the Federal Government during such treatment.</text>
</subsection><subsection id="H11A1C5D237234C958EE33841AB878C0F"><enum>(c)</enum><header>Construction</header><text>Nothing in this section may be construed to remove, limit, or otherwise affect any obligation of a covered health care professional under the Controlled Substances Act (<external-xref legal-doc="usc" parsable-cite="usc/21/801">21 U.S.C. 801</external-xref> et seq.).</text>
</subsection><subsection id="H16FD5FB9EC6442548F6EDBC294BC7062"><enum>(d)</enum><header>Covered health care professional defined</header><text>In this section, the term <term>covered health care professional</term> means a health care professional who—</text> <paragraph id="HB2B5D6884A1E49E4824B10B622ECBDEF"><enum>(1)</enum><text>is an employee of the Department appointed under the authority under section 7306, 7401, 7405, 7406, or 7408 of this title, or title 5;</text>
</paragraph><paragraph id="H9CD8AC8C539B4750A60FD993117FF23E"><enum>(2)</enum><text>is authorized by the Secretary to provide health care under this chapter;</text> </paragraph><paragraph id="H3E116998C890405BA85FE11F2D8D4F1D"><enum>(3)</enum><text>is required to adhere to all quality standards relating to the provision of telemedicine in accordance with applicable policies of the Department; and</text>
</paragraph><paragraph id="H72B11439A955490EA728D85373A460BC"><enum>(4)</enum><text>has an active, current, full, and unrestricted license, registration, or certification in a State to practice the health care profession of the health care professional.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="H15ABD85338C447069E28A95550C99591"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title is further amended by inserting after the item relating to section 1730A the following new item:</text>
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<toc regeneration="no-regeneration">
<toc-entry level="section">1730B. Licensure of health care professionals providing treatment via telemedicine.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="HD5C33C3AF333447696A99796AD66ACE7"><enum>(c)</enum><header>Report on telemedicine</header>
<paragraph id="HA3396C7F09034365AA39A768A3D4AE2F"><enum>(1)</enum><header>In general</header><text>Not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs 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 effectiveness of the use of telemedicine by the Department of Veterans Affairs.</text>
</paragraph><paragraph id="H756150ABC5FB40D3808E2ECDDE984A55"><enum>(2)</enum><header>Elements</header><text>The report required by paragraph (1) shall include an assessment of the following:</text> <subparagraph id="H18AFAAAE55F34506AA76289A37F7E9AC"><enum>(A)</enum><text>The satisfaction of veterans with telemedicine furnished by the Department.</text>
</subparagraph><subparagraph id="H0FBBC1A819DD401D9742D8A7448B4971"><enum>(B)</enum><text>The satisfaction of health care providers in providing telemedicine furnished by the Department.</text> </subparagraph><subparagraph id="H03E521EE9F08480B93644DFE1FFA20AB"><enum>(C)</enum><text>The effect of telemedicine furnished by the Department on the following:</text>
<clause id="HEA2C999B939C481C8F74AB5F70BC53C3"><enum>(i)</enum><text>The ability of veterans to access health care, whether from the Department or from non-Department health care providers.</text>
</clause><clause id="H45B900C508704583BEBCB086989F9651"><enum>(ii)</enum><text>The frequency of use by veterans of telemedicine.</text> </clause><clause id="H218EACB6AE414E39A028D3230C7D80B4"><enum>(iii)</enum><text>The productivity of health care providers.</text>
</clause><clause id="HA7186F66075F4FB19DC49A3949868A3B"><enum>(iv)</enum><text>Wait times for an appointment for the receipt of health care from the Department.</text> </clause><clause id="H71083BE6FE114D6FB830C461D82BAC2B"><enum>(v)</enum><text>The reduction, if any, in the use by veterans of in-person services at Department facilities and non-Department facilities.</text>
</clause></subparagraph><subparagraph id="HBBD42B3C005F43FE80EFA0AC954181F7"><enum>(D)</enum><text>The types of appointments for the receipt of telemedicine furnished by the Department that were provided during the one-year period preceding the submittal of the report.</text>
</subparagraph><subparagraph id="H03DF6BA3DF51429F9F8095D9A571309F"><enum>(E)</enum><text>The number of appointments for the receipt of telemedicine furnished by the Department that were requested during such period, disaggregated by Veterans Integrated Service Network.</text>
</subparagraph><subparagraph id="HC7EEE3FFC21145D08A11C3D1FE8A79A8"><enum>(F)</enum><text>Savings by the Department, if any, including travel costs, of furnishing health care through the use of telemedicine during such period.</text>
</subparagraph></paragraph></subsection></section>