,,ii #aacth ,,congress #b;d ,session ,s4 #bdbd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #c1 #bjad ,mr4 ,mc,cain 7for himself1 ,mr4 ,coburn1 ,mr4 ,burr1 ,mr4 ,flake1 ,mr4 ,isakson1 ,mr4 ,inhofe1 ,mr4 ,grassley1 ,mr4 ,roberts1 ,mr4 ,hoeven1 ,mr4 ,coats1 ,mr4 ,barrasso1 ,mr4 ,johanns1 ,mr4 ,rubio1 ,mr4 ,cornyn1 ,mr4 ,alexander1 ,mr4 ,kirk1 ,mr4 ,wicker1 ,mrs4 ,fischer1 ,mr4 ,portman1 ,mr4 ,toomey1 ,mr4 ,boozman1 ,mr4 ,moran1 ,mr4 ,thune1 ,mr4 ,scott1 ,mr4 ,enzi1 and ,mr4 ,graham7 introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,a ,,bill ,to provide veterans with the choice of medical providers and to increase transparency and accountability of operations of the ,veterans ,health ,administration of the ,department of ,veterans ,affairs1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,veterans ,choice ,act of #bjad4 #b4 ,expanded availability of hospital care and medical services for veterans through the use of contracts 7a7 ,expansion of available care and services 7#a7 ,in general ,hospital care and medical services under chapter #ag of title #ch1 ,united ,states ,code1 shall be furnished to an eligible veteran described in subsection 7b71 at the election of such veteran1 through contracts authorized under subsection 7d71 or any other law administered by the ,secretary of ,veterans ,affairs1 with health care providers that are participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for the furnishing of such care and services to veterans4 7#b7 ,choice of provider ,an eligible veteran who elects to receive care and services under this section may select the provider of such care and services from among any source of provider of such care and services specified in paragraph 7#a7 that is accessible to the veteran4 7b7 ,eligible veterans ,a veteran is an eligible veteran for purposes of this section if-- 7#a7 7,a7 the veteran is enrolled in the patient enrollment system of the ,department of ,veterans ,affairs established and operated under section #agje of title #ch1 ,united ,states ,code2 or 7,b7 the veteran is enrolled in such system1 has not received hospital care and medical services from the ,department1 and has contacted the ,department seeking an initial appointment from the ,department for the receipt of such care and services2 and 7#b7 the veteran either-- 7,a7 7i7 attempts1 or has attempted under paragraph 7#a77;,b71 to schedule an appointment for the receipt of such care and services but is unable to schedule an appointment within the current wait-time goals of the ,veterans ,health ,administration for the delivery of such care and services2 and 7ii7 elects1 and is authorized1 to be furnished such care or services pursuant to subsection 7c77#b72 or 7,b7 resides more than #dj miles from the nearest medical facility of the ,department1 including a community-based outpatient clinic1 that is closest to the residence of the veteran4 7c7 ,election and authorization ,if the ,secretary confirms that an appointment for an eligible veteran described in subsection 7b77#b77;,a7 for the receipt of hospital care or medical services under chapter #ag of title #ch1 ,united ,states ,code1 is unavailable within the current wait-time goals of the ,department for the furnishing of such care or services1 the ,secretary shall1 at the election of the eligible veteran-- 7#a7 place such eligible veteran on an electronic waiting list for such an appointment that is maintained by the ,department and accessible to the veteran via www4myhealth4va4gov or any successor website2 or 7#b7 7,a7 authorize that such care and services be furnished to the eligible veteran under this section for a period of time specified by the ,secretary2 and 7,b7 send a letter to the eligible veteran describing the care and services the eligible veteran is eligible to receive under this section4 7d7 ,care and services through contracts 7#a7 ,in general ,the ,secretary shall enter into contracts with health care providers that are participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 to furnish care and services to eligible veterans under this section4 7#b7 ,rates and reimbursement 7,a7 ,in general ,in entering into a contract under this subsection1 the ,secretary shall-- 7i7 negotiate rates for the furnishing of care and services under this section2 and 7ii7 reimburse the health care provider for such care and services at the rates negotiated pursuant to clause 7i7 as provided in such contract4 7,b7 ,limit on rates ,rates negotiated under subparagraph 7,a77i7 shall not be more than the rates paid by the ,united ,states to a provider of services 7as defined in section #ahfa7u7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7u777 or a supplier 7as defined in section #ahfa7;d7 of such ,act 7#db ,u4,s4,c4 #aciex7d777 under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 for the same care and services4 7,c7 ,limit on collection ,for the furnishing of care and services pursuant to a contract under this section1 a health care provider may not collect any amount that is greater than the rate negotiated pursuant to subparagraph 7,a77i74 7#c7 ,information on policies and procedures ,the ,secretary shall provide to any health care provider with which the ,secretary has entered into a contract under paragraph 7#a7 the following3 7,a7 ,information on applicable policies and procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section4 7,b7 ,access to a telephone hotline maintained by the ,department that such health care provider may call for information on the following3 7i7 ,procedures for furnishing care and services under this section4 7ii7 ,procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services4 7iii7 ,whether particular care or services under this section are authorized1 and the procedures for authorization of such care or services4 7e7 ,choice card 7#a7 ,in general ,for purposes of receiving care and services under this section1 the ,secretary shall issue to each eligible veteran a card that the eligible veteran shall present to a health care provider that is eligible to furnish care and services under this section before receiving such care and services4 7#b7 ,name of card ,each card issued under paragraph 7#a7 shall be known as a ,choice ,card4 7#c7 ,details of card ,each ,choice ,card issued to an eligible veteran under paragraph 7#a7 shall include the following3 7,a7 ,the name of the eligible veteran4 7,b7 ,an identification number for the eligible veteran that is not the social security number of the eligible veteran4 7,c7 ,the contact information of an appropriate office of the ,department for health care providers to confirm that care and services under this section is authorized for the eligible veteran4 7,d7 ,contact information and other relevant information for the submittal of claims or bills for the furnishing of care and services under this section4 7,e7 ,the following statement3 ,this card is for qualifying medical care outside the ,department of ,veterans ,affairs4 ,please call the ,department of ,veterans ,affairs phone number specified on this card to ensure that treatment has been authorized44 7#d7 ,information on use of card ,upon issuing a ,choice ,card to an eligible veteran1 the ,secretary shall provide the eligible veteran with information clearly stating the circumstances under which the veteran may be eligible for care and services under this section4 7f7 ,information on availability of care ,the ,secretary shall provide information to a veteran about the availability of care and services under this section in the following circumstances3 7#a7 ,when the veteran enrolls in the patient enrollment system of the ,department under section #agje of title #ch1 ,united ,states ,code4 7#b7 ,when the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the ,department but is unable to schedule an appointment within the current wait-time goals of the ,veterans ,health ,administration for delivery of such care or services4 7g7 ,providers ,to be eligible to furnish care and services under this section1 a health care provider must maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the ,department1 as determined by the ,secretary for purposes of this section4 7h7 ,cost-,sharing ,the ,secretary shall require an eligible veteran to pay a copayment to the ,department for the receipt of care and services under this section only if the eligible veteran would be required to pay such copayment for the receipt of such care and services at a medical facility of the ,department4 7i7 ,claims processing system 7#a7 ,in general ,the ,secretary shall provide for an efficient nationwide system for processing and paying bills or claims for authorized care and services furnished to eligible veterans under this section4 7#b7 ,regulations ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall prescribe regulations for the implementation of the efficient nationwide system required by paragraph 7#a74 7j7 ,continuity of medical records ,the ,secretary shall ensure that medical records of veterans maintained by the ,department are updated to accurately reflect any care and services furnished under this section4 7k7 ,tracking of missed appointments ,the ,secretary shall implement a mechanism to track any missed appointments for care and services under this section by eligible veterans to ensure that the ,department does not pay for such care and services that were not furnished4 7l7 ,implementation ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary shall prescribe interim final regulations on the implementation of this section and publish such regulations in the ,federal ,register4 7m7 ,inspector ,general audit ,not later than #edj days after the publication of the interim final regulations under subsection 7l71 the ,inspector ,general of the ,department shall conduct an audit of care and services furnished under this section to ensure the accuracy of payments by the ,department for the cost of care and services furnished under this section4 7n7 ,termination ,the requirement of the ,secretary to furnish care and services under this section terminates on the date that is two years after the date on which the ,secretary publishes the interim final regulations under subsection 7l74 7o7 ,reports ,not less frequently than once every #ij days1 the ,secretary shall submit to ,congress a report on the furnishing of care and services under this section that includes the following3 7#a7 ,the number of veterans who have received care and services under this section during the #ij-;day period preceding the submittal of the report4 7#b7 ,a description of the type of care and services furnished to veterans under this section during such #ij-;day period4 #c4 ,sense of ,congress on prompt payment by ,department of ,veterans ,affairs ,it is the sense of ,congress that the ,secretary of ,veterans ,affairs shall comply with section #acae of title #e1 ,code of ,federal ,regulations 7commonly known as the prompt payment rule71 or any corresponding similar regulation or ruling1 in paying for health care pursuant to contracts entered into with non-,department of ,veterans ,affairs providers to provide health care under the laws administered by the ,secretary4 #d4 ,improved performance metrics for health care provided by ,department of ,veterans ,affairs 7a7 ,prohibition on use of scheduling and wait-,time metrics in determination of performance awards ,the ,secretary shall ensure that scheduling and wait-time metrics or goals are not used as factors in determining the performance of the following employees for purposes of determining whether to pay performance awards to such employees3 7#a7 ,directors1 associate directors1 assistant directors1 deputy directors1 chiefs of staff1 and clinical leads of medical centers of the ,department4 7#b7 ,directors1 assistant directors1 and quality management officers of ,veterans ,integrated ,service ,networks of the ,department4 7b7 ,modification of performance plans 7#a7 ,in general ,not later than #cj days after the date of the enactment of this ,act1 the ,secretary shall modify the performance plans of the directors of the medical centers of the ,department and the directors of the ,veterans ,integrated ,service ,networks to ensure that such plans are based on the quality of care received by veterans at the health care facilities under the jurisdictions of such directors4 7#b7 ,factors ,in modifying performance plans under paragraph 7#a71 the ,secretary shall ensure that assessment of the quality of care provided at health care facilities under the jurisdiction of a director described in paragraph 7#a7 includes consideration of the following3 7,a7 ,recent reviews by the ,joint ,commission 7formerly known as the ,joint ,commission on ,accreditation of ,healthcare ,organizations7 of such facilities4 7,b7 ,the number and nature of recommendations concerning such facilities by the ,inspector ,general of the ,department in reviews conducted through ,combined ,assessment ,program 7,,cap7 reviews1 in the reviews by the ,inspector ,general of community-based outpatient clinics and primary care clinics1 and in reviews conducted through the ,office of ,healthcare ,inspections during the two most recently completed fiscal years4 7,c7 ,the number of recommendations described in subparagraph 7,b7 that the ,inspector ,general of the ,department determines have not been carried out satisfactorily with respect to such facilities4 7,d7 ,reviews of such facilities by the ,commission on ,accreditation of ,rehabilitation ,facilities4 7,e7 ,the number and outcomes of administrative investigation boards1 root cause analysis1 and peer reviews conducted at such facilities during the fiscal year for which the assessment is being conducted4 7,f7 ,the effectiveness of any remedial actions or plans resulting from any ,inspector ,general recommendations in the reviews and analyses described in subparagraphs 7,a7 through 7,e74 7#c7 ,additional leadership positions ,to the degree practicable1 the ,secretary shall assess the performance of other employees of the ,department in leadership positions at ,department medical centers1 including associate directors1 assistant directors1 deputy directors1 chiefs of staff1 and clinical leads1 and in ,veterans ,integrated ,service ,networks1 including assistant directors and quality management officers1 using factors and criteria similar to those used in the performance plans modified under paragraph 7#a74 #e4 ,improved transparency concerning health care provided by ,department of ,veterans ,affairs 7a7 ,publication of wait times 7#a7 ,goals 7,a7 ,initial ,not later than #ij days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall publish in the ,federal ,register1 and on an ,internet website accessible to the public of each medical center of the ,department of ,veterans ,affairs1 the wait-time goals of the ,department for the scheduling of an appointment by a veteran for the receipt of health care from the ,department4 7,b7 ,subsequent changes 7i7 ,in general ,if the ,secretary modifies the wait-time goals described in subparagraph 7,a71 the ,secretary shall publish the new wait-time goals-- 7,i7 on an ,internet website accessible to the public of each medical center of the ,department not later than #cj days after such modification2 and 7,,ii7 in the ,federal ,register not later than #ij days after such modification4 7ii7 ,effective date ,any modification under clause 7i7 shall take effect on the date of publication in the ,federal ,register4 7,c7 ,goals described ,wait-time goals published under this paragraph shall include goals for primary care appointments1 specialty care appointments1 and goals for such appointments based on the general severity of the condition of the veteran4 7#b7 ,wait times at medical centers of the ,department ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall publish on an ,internet website accessible to the public of each medical center of the ,department the current wait time for an appointment for primary care and specialty care at the medical center4 7b7 ,publicly available database of patient safety1 quality of care1 and outcome measures 7#a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary shall develop and make available to the public a comprehensive database containing all applicable patient safety1 quality of care1 and outcome measures for health care provided by the ,department that are tracked by the ,secretary4 7#b7 ,update frequency ,the ,secretary shall update the database required by paragraph 7#a7 not less frequently than once each year4 7#c7 ,unavailable measures ,for all measures that the ,secretary would otherwise publish in the database required by paragraph 7#a7 but has not done so because such measures are not available1 the ,secretary shall publish notice in the database of the reason for such unavailability and a timeline for making such measures available in the database4 7#d7 ,accessibility ,the ,secretary shall ensure that the database required by paragraph 7#a7 is accessible to the public through the primary ,internet website of the ,department and through each primary ,internet website of a ,department medical center4 7c7 ,hospital ,compare website of ,department of ,health and ,human ,services 7#a7 ,agreement required ,not later than #ahj days after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall enter into an agreement with the ,secretary of ,health and ,human ,services for the provision by the ,secretary of ,veterans ,affairs of such information as the ,secretary of ,health and ,human ,services may require to report and make publicly available patient quality and outcome information concerning ,department of ,veterans ,affairs medical centers through the ,hospital ,compare ,internet website of the ,department of ,health and ,human ,services or any successor ,internet website4 7#b7 ,information provided ,the information provided by the ,secretary of ,veterans ,affairs to the ,secretary of ,health and ,human ,services under paragraph 7#a7 shall include the following3 7,a7 ,measures of timely and effective health care4 7,b7 ,measures of readmissions1 complications of death1 including with respect to #cj-;day mortality rates and #cj-;day readmission rates1 surgical complication measures1 and health care related infection measures4 7,c7 ,survey data of patient experiences1 including the ,hospital ,consumer ,assessment of ,healthcare ,providers and ,systems or any similar successor survey developed by the ,department of ,health and ,human ,services4 7,d7 ,any other measures required of or reported with respect to hospitals participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq474 7#c7 ,unavailable information ,for any applicable metric collected by the ,department of ,veterans ,affairs or required to be provided under paragraph 7#b7 and withheld from or unavailable in the ,hospital ,compare ,internet website1 the ,secretary of ,veterans ,affairs shall publish a notice in the ,federal ,register stating the reason why such metric was withheld from public disclosure and a timeline for making such metric available1 if applicable4 7d7 ,comptroller ,general review of publicly available safety and quality metrics ,not later than three years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall conduct a review of the safety and quality metrics made publicly available by the ,secretary of ,veterans ,affairs under this section to assess the degree to which the ,secretary is complying with the provisions of this section4 #f4 ,information for veterans on the credentials of ,department of ,veterans ,affairs physicians 7a7 ,improvement of ,our ,providers ,internet website links 7#a7 ,availability through ,department of ,veterans ,affairs homepage ,a link to the ,our ,providers health care providers database of the ,department of ,veterans ,affairs1 or any successor database1 shall be available on and through the homepage of the ,internet website of the ,department that is accessible to the public4 7#b7 ,information on location of residency training ,the ,internet website of the ,department that is accessible to the public shall include under the link to the ,our ,providers health care providers database of the ,department1 or any successor database1 the location of residency training of each licensed physician of the ,department4 7#c7 ,information on physicians at particular facilities ,the ,our ,providers health care providers database of the ,department1 or any successor database1 shall identify whether each licensed physician of the ,department is a physician in residency4 7b7 ,information on credentials of physicians for veterans undergoing surgical procedures ,each veteran who is undergoing a surgical procedure by or through the ,department shall be provided1 at such time in advance of the procedure as is appropriate to permit such veteran to evaluate such information1 information on the credentials of the surgeon to be performing such procedure4 7c7 ,,gao report ,not later than two years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committees on ,veterans' ,affairs of the ,senate and the ,house of ,representatives a report setting forth an assessment by the ,comptroller ,general of the following3 7#a7 ,the manner in which contractors under the ,patient-,centered ,community ,care initiative of the ,department perform oversight of the credentials of physicians within the networks of such contractors under the initiative4 7#b7 ,the oversight by the ,department of the contracts under the ,patient-,centered ,community ,care initiative4 #g4 ,information in annual budget of the ,president on hospital care and medical services provided under section #b ,the materials on the ,department of ,veterans ,affairs in the budget of the ,president for a fiscal year1 as submitted to ,congress pursuant to section #aaje7;a7 of title #ca1 ,united ,states ,code1 shall set forth the following3 7#a7 ,the number of veterans who received hospital care and medical services under section #b of this ,act during the fiscal year preceding the fiscal year in which such budget is submitted4 7#b7 ,the amount expended by the ,department on furnishing care and services under such section during the fiscal year preceding the fiscal year in which such budget is submitted4 7#c7 ,the amount requested in such budget for the costs of furnishing care and services under such section during the fiscal year covered by such budget1 set forth in aggregate and by amounts for each account for which amounts are so requested4 7#d7 ,the number of veterans that the ,department estimates will receive hospital care and medical services under such section during the fiscal years covered by the budget submission4 7#e7 ,the number of employees of the ,department on paid administrative leave at any point during the fiscal year preceding the fiscal year in which such budget is submitted4 #h4 ,prohibition on falsification of data concerning wait times and quality measures at ,department of ,veterans ,affairs ,not later than #fj days after the date of the enactment of this ,act1 and in accordance with title #e1 ,united ,states ,code1 the ,secretary of ,veterans ,affairs shall establish policies whereby any employee of the ,department of ,veterans ,affairs who knowingly submits false data concerning wait times for health care or quality measures with respect to health care to another employee of the ,department or knowingly requires another employee of the ,department to submit false data concerning such wait times or quality measures to another employee of the ,department is subject to a penalty the ,secretary considers appropriate after notice and an opportunity for a hearing1 including civil penalties1 unpaid suspensions1 or termination4 #i4 ,removal of ,senior ,executive ,service employees of the ,department of ,veterans ,affairs for performance 7a7 ,in general ,chapter #g of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #gac4 ,senior ,executive ,service3 removal based on performance 7a7 ,in general 7#a7 ,notwithstanding subchapter ,v of chapter #ce of title #e1 subchapter ,v of chapter #ge of title #e1 or any other provision of law1 the ,secretary may remove any individual who is an employee of the ,department from a ,senior ,executive ,service position 7as defined in section #cacb7;a7 of title #e7 if the ,secretary determines the performance of the individual warrants such removal4 7#b7 ,if the ,secretary so removes such an individual1 the ,secretary may-- 7,a7 remove the individual from the civil service 7as defined in section #baja of title #e72 or 7,b7 appoint the individual to a ,general ,schedule position at any grade of the ,general ,schedule the ,secretary determines appropriate4 7b7 ,notice to ,congress ,not later than #cj days after removing an individual from the ,senior ,executive ,service under subsection 7a71 the ,secretary shall submit to the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives notice in writing of such removal and the reason for such removal4 7c7 ,manner of removal ,a removal under this section shall be done in the same manner as the removal of a professional staff member employed by a ,member of ,congress4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by adding at the end the following new item3 #gac4 ,senior ,executive ,service3 removal based on performance4 4