,i  #aadth ,,congress  #ast ,session    
,h4 ,r4 #dajc  ,,in ,,the ,,house ,,of  
,,representatives  ,november #ai1 #bjae 
,mr4 ,cramer introduced the following   
bill2 which was referred to the         
,committee on ,veterans' ,affairs1 and  
in addition to the ,committee on ,ways  
and ,means1 for a period to be          
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to amend title #ch1 ,united 
,states ,code1 to improve the provision 
of medical care to veterans at critical 
access hospitals4  #a4 ,short title     
,this ,act may be cited as the ,critical
 ,access ,hospitals for ,veterans ,act  
or the ,,cahv ,act4  #b4 ,care to       
veterans at critical access hospitals   
7a7 ,agreement between ,,hhs and ,,va   
7#a7 ,in general ,chapter #ag of title  
#ch1 ,united ,states ,code1 is amended  
by inserting after section #agjc the    
following new section3  #agjc;,a4 ,care 

at critical access hospitals  7a7       
,furnishing of care ,at the election of 
a veteran enrolled in the health care   
system established under section        
#agje7;a7 of this title1 hospital care  
and medical services shall be furnished 
at critical access hospitals to the     
veteran pursuant to the agreement       
described in subsection 7b77#a74  7b7   
,agreement  7#a7 ,the agreement         
described in this paragraph is an       
agreement entered into by the ,secretary
 of ,veterans ,affairs and the          
,secretary of ,health and ,human        
,services under which--  7,a7 the       
,secretary of ,health and ,human        
,services1 acting through the ,centers  
for ,medicare  ,medicaid ,services1     
shall1 notwithstanding any other        
provision of law-- 7i7 ensure that a    
critical access hospital may submit     
claims to the ,centers for ,medicare    
,medicaid ,services for hospital care   
and medical services that are inpatient 
critical access hospital services and   

outpatient critical access hospital     
services 7as such terms are defined in  
paragraphs 7#b7 and 7#c71 respectively1 
of section #ahfa7mm7 of the ,social     
,security ,act 7#db ,u4,s4,c4           
#aciex7mm777 furnished to a veteran     
under subsection 7a72 and  7ii7 subject 
to paragraphs 7#b7 and 7#c71 provide    
payment to such critical access hospital
 for such services furnished to such    
veteran in the same manner and at #ajj  
percent of the payment rate as would    
otherwise be made to such critical      
access hospital 7including any          
cost-sharing obligation that would      
otherwise apply7 if such services were  
furnished to an individual entitled to  
benefits under part ,a of title ,,xviii 
of the ,social ,security ,act or        
enrolled under part ,b of such ,act1 as 
applicable2 and  7,b7 not later than #cj
 days after the ,secretary of ,health   
and ,human ,services provides such      
payment to such critical access         
hospital1 the ,secretary of ,veterans   

,affairs shall reimburse the ,secretary 
of ,health and ,human ,services an      
amount equal to--  7i7 the payment      
provided to the critical access hospital
 pursuant to subparagraph 7,a7 with     
respect to such services described in   
such subparagraph furnished to such     
veteran1 minus  7ii7 any portion of such
 payment for such services furnished to 
such veteran for which payment would    
otherwise be made under title ,,xviii of
 such ,act 7including any cost-sharing  
obligation that would otherwise apply7  
with respect to such veteran1 without   
application of this subsection1 and     
which would not otherwise be provided   
pursuant to this chapter4  7#b7 ,in the 
case of care or services furnished to a 
veteran by a critical access hospital   
for which payment would not be made     
under title ,,xviii of the ,social      
,security ,act if such veteran were an  
individual entitled to benefits under   
part ,a of such title or enrolled under 
part ,b1 as applicable1 the ,secretary  

of ,veterans ,affairs and the ,secretary
 of ,health and ,human ,services shall  
jointly determine the payment to be made
 under paragraph 7#a77;,a7 to such      
critical access hospital for such care  
or services furnished to such veteran4  
,subparagraphs 7,a77i7 and 7,b7 of      
paragraph 7#a7 shall apply with respect 
to such care and services and any       
payments made pursuant to the previous  
sentence1 respectively1 in the same     
manner as such subparagraphs apply to   
services described in and payments made 
under subparagraph 7,a77ii7 of such     
paragraph4  7#c7 ,in the case of        
services described in paragraph         
7#a77;,b77ii7 furnished to a veteran for
 which payment would otherwise be made  
under title ,,xviii of the ,social      
,security ,act1 any cost-sharing        
obligation otherwise applicable to such 
veteran under such title with respect to
 such services shall apply4  7c7        
,eligibility ,a veteran shall be        
eligible for the hospital care and      

medical services furnished under        
subsection 7a7 if the veteran presents  
to a critical access hospital and       
provides the critical access hospital   
with any document issued by the         
,department of ,veterans ,affairs that  
describes the enrollment of the veteran 
in the health care system established   
under section #agje7;a7 of this title1  
including an identification card        
described in section #egjf7;f7 of this  
title or a ,veterans ,choice ,card      
described in section #aja7;f7 of the    
,veterans ,access1 ,choice1 and         
,accountability ,act of #bjad 7#ch      
,u4,s4,c4 #agja note74  7d7 ,care       
provided ,the hospital care and medical 
services furnished to a veteran under   
subsection 7a7 shall be the care or     
services the eligible veteran is        
eligible to receive under this chapter4 
7e7 ,medical records ,the ,secretary of 
,veterans ,affairs shall provide to a   
critical access hospital the medical    
records of a veteran being treated by   

such hospital if such hospital requests 
such records4 ,to the extent            
practicable1 the ,secretary shall       
provide such records electronically4    
7f7 ,costs to veterans ,any copayments  
or other charges that the ,secretary may
 collect from a veteran or third party  
pursuant to this chapter for hospital   
care or medical services furnished to a 
veteran at a non-,department facility   
shall apply to care or services         
furnished to the veteran under          
subsection 7a74  7g7 ,reports ,during   
the five-year period beginning on the   
date of the enactment of this section1  
and from time to time thereafter1 the   
,secretary of ,veterans ,affairs1 in    
consultation with the ,secretary of     
,health and ,human ,services1 shall     
submit to the ,committees on ,veterans' 
,affairs and ,energy and ,commerce of   
the ,house of ,representatives and the  
,committees on ,veteran's ,affairs and  
,health1 ,education1 ,labor1 and        
,pensions of the ,senate an annual      

report on the hospital care and medical 
services furnished under subsection 7a74
 ,each such report shall explain how    
furnishing such care and services under 
subsection 7a7 affects the following3   
7#a7 ,the resources of the ,department  
of ,veterans ,affairs4  7#b7 ,the costs 
incurred by veterans to receive such    
care and services4  7#c7 ,the amount of 
time a veteran must wait to receive     
hospital care and services4  7h7        
,critical access hospital defined ,in   
this section1 the term critical access  
hospital means a hospital designated or 
certified as a critical access hospital 
pursuant to section #ahbj of the ,social
 ,security ,act 7#db ,u4,s4,c4          
#acie;i-#d74  4  7#b7 ,clerical         
amendment ,the table of sections at the 
beginning of such chapter is amended by 
inserting after the item relating to    
section #agjc the following new item3   
#agjc;,a4 ,care at critical access      
hospitals4  4  7b7 ,medicare condition  
of participation ,section #ahbj7;e7 of  

the ,social ,security ,act 7#db         
,u4,s4,c4 #acie;i-#d7;e77 is amended--  
7#a7 in paragraph 7#b71 by striking at  
the end and2  7#b7 by redesignating     
paragraph 7#c7 as paragraph 7#d72 and   
7#c7 by inserting after paragraph 7#b7  
the following new paragraph3  7#c7      
agrees to furnish items and services to 
veterans in accordance with the         
agreement entered into between the      
,secretary and the ,secretary of        
,veterans ,affairs under section        
#agjc;,a of title #ch1 ,united ,states  
,code2 and  4