,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #dajc  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #ai1 #bjae   
,mr4 ,cram] introduc$ ! foll[+ bill2 :i*
 0 ref]r$ to ! ,committee on ,vet]ans'  
,affairs1 & 9 addition to ! ,committee  
on ,ways & ,means1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title #ch1 
,unit$ ,/ates ,code1 to improve !       
provision ( m$ical c>e to vet]ans at    
critical access hospitals4  #a4 ,%ort   
title ,?is ,act may be cit$ z !         
,critical ,access ,hospitals = ,vet]ans 
,act or ! ,,cahv ,act4  #b4 ,c>e to     
vet]ans at critical access hospitals    
7a7 ,agreem5t betwe5 ,,hhs & ,,va  7#a7 
,9 g5]al ,*apt] #ag ( title #ch1 ,unit$ 
,/ates ,code1 is am5d$ by ins]t+ aft]   
section #agjc ! foll[+ new section3     
#agjc;,a4 ,c>e at critical access       
hospitals  7a7 ,furni%+ ( c>e ,at !     
election ( a vet]an enroll$ 9 ! heal?   

c>e sy/em e/abli%$ "u section #agje7;a7 
( ?is title1 hospital c>e & m$ical      
s]vices %all be furni%$ at critical     
access hospitals to ! vet]an pursuant to
 ! agreem5t describ$ 9 subsection       
7b77#a74  7b7 ,agreem5t  7#a7 ,!        
agreem5t describ$ 9 ?is p>agraph is an  
agreem5t ent]$ into by ! ,secret>y (    
,vet]ans ,affairs & ! ,secret>y ( ,heal?
 & ,human ,s]vices "u :i*--  7,a7 !     
,secret>y ( ,heal? & ,human ,s]vices1   
act+ ?r\gh ! ,c5t]s = ,m$ic>e  ,m$icaid 
,s]vices1 %all1 not)/&+ any o!r         
provision ( law-- 7i7 ensure t a        
critical access hospital may submit     
claims to ! ,c5t]s = ,m$ic>e  ,m$icaid  
,s]vices = hospital c>e & m$ical s]vices
 t are inpati5t critical access hospital
 s]vices & outpati5t critical access    
hospital s]vices 7z su* t]ms are def9$ 9
 p>agraphs 7#b7 & 7#c71 respectively1 ( 
section #ahfa7mm7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #aciex7mm777 furni%$
 to a vet]an "u subsection 7a72 &  7ii7 
subject to p>agraphs 7#b7 & 7#c71       

provide paym5t to su* critical access   
hospital = su* s]vices furni%$ to su*   
vet]an 9 ! same mann] & at #ajj p]c5t ( 
! paym5t rate z w\ld o!rwise be made to 
su* critical access hospital 7includ+   
any co/-%>+ obligation t w\ld o!rwise   
apply7 if su* s]vices 7 furni%$ to an   
individual entitl$ to b5efits "u "p ,a (
 title ,,xviii ( ! ,social ,security    
,act or enroll$ "u "p ,b ( su* ,act1 z  
applicable2 &  7,b7 n lat] ?an #cj days 
aft] ! ,secret>y ( ,heal? & ,human      
,s]vices provides su* paym5t to su*     
critical access hospital1 ! ,secret>y ( 
,vet]ans ,affairs %all reimburse !      
,secret>y ( ,heal? & ,human ,s]vices an 
am\nt equal to--  7i7 ! paym5t provid$  
to ! critical access hospital pursuant  
to subp>agraph 7,a7 ) respect to su*    
s]vices describ$ 9 su* subp>agraph      
furni%$ to su* vet]an1 m9us  7ii7 any   
portion ( su* paym5t = su* s]vices      
furni%$ to su* vet]an = :i* paym5t w\ld 
o!rwise be made "u title ,,xviii ( su*  
,act 7includ+ any co/-%>+ obligation t  

w\ld o!rwise apply7 ) respect to su*    
vet]an1 )\t application ( ?is           
subsection1 & :i* w\ld n o!rwise be     
provid$ pursuant to ?is *apt]4  7#b7 ,9 
! case ( c>e or s]vices furni%$ to a    
vet]an by a critical access hospital =  
:i* paym5t w\ld n be made "u title      
,,xviii ( ! ,social ,security ,act if   
su* vet]an 7 an individual entitl$ to   
b5efits "u "p ,a ( su* title or enroll$ 
"u "p ,b1 z applicable1 ! ,secret>y (   
,vet]ans ,affairs & ! ,secret>y ( ,heal?
 & ,human ,s]vices %all jo9tly det]m9e !
 paym5t to be made "u p>agraph 7#a77;,a7
 to su* critical access hospital = su*  
c>e or s]vices furni%$ to su* vet]an4   
,subp>agraphs 7,a77i7 & 7,b7 ( p>agraph 
7#a7 %all apply ) respect to su* c>e &  
s]vices & any paym5ts made pursuant to !
 previ\s s5t5ce1 respectively1 9 ! same 
mann] z su* subp>agraphs apply to       
s]vices describ$ 9 & paym5ts made "u    
subp>agraph 7,a77ii7 ( su* p>agraph4    
7#c7 ,9 ! case ( s]vices describ$ 9     
p>agraph 7#a77;,b77ii7 furni%$ to a     

vet]an = :i* paym5t w\ld o!rwise be made
 "u title ,,xviii ( ! ,social ,security 
,act1 any co/-%>+ obligation o!rwise    
applicable to su* vet]an "u su* title ) 
respect to su* s]vices %all apply4  7c7 
,eligibility ,a vet]an %all be eligible 
= ! hospital c>e & m$ical s]vices       
furni%$ "u subsection 7a7 if ! vet]an   
pres5ts to a critical access hospital & 
provides ! critical access hospital )   
any docum5t issu$ by ! ,dep>tm5t (      
,vet]ans ,affairs t describes !         
enrollm5t ( ! vet]an 9 ! heal? c>e sy/em
 e/abli%$ "u section #agje7;a7 ( ?is    
title1 includ+ an id5tification c>d     
describ$ 9 section #egjf7;f7 ( ?is title
 or a ,vet]ans ,*oice ,c>d describ$ 9   
section #aja7;f7 ( ! ,vet]ans ,access1  
,*oice1 & ,acc\ntability ,act ( #bjad   
7#ch ,u4,s4,c4 #agja note74  7d7 ,c>e   
provid$ ,! hospital c>e & m$ical s]vices
 furni%$ to a vet]an "u subsection 7a7  
%all be ! c>e or s]vices ! eligible     
vet]an is eligible to receive "u ?is    
*apt]4  7e7 ,m$ical records ,! ,secret>y

 ( ,vet]ans ,affairs %all provide to a  
critical access hospital ! m$ical       
records ( a vet]an be+ treat$ by su*    
hospital if su* hospital reque/s su*    
records4 ,to ! ext5t practicable1 !     
,secret>y %all provide su* records      
electronically4  7f7 ,co/s to vet]ans   
,any copaym5ts or o!r *>ges t !         
,secret>y may collect f a vet]an or ?ird
 p>ty pursuant to ?is *apt] = hospital  
c>e or m$ical s]vices furni%$ to a      
vet]an at a non-,dep>tm5t facility %all 
apply to c>e or s]vices furni%$ to !    
vet]an "u subsection 7a74  7g7 ,reports 
,dur+ ! five-ye> p]iod beg9n+ on ! date 
( ! enactm5t ( ?is section1 & f "t to "t
 !reaft]1 ! ,secret>y ( ,vet]ans        
,affairs1 9 consultation ) ! ,secret>y (
 ,heal? & ,human ,s]vices1 %all submit  
to ! ,committees on ,vet]ans' ,affairs &
 ,en]gy & ,comm]ce ( ! ,h\se (          
,repres5tatives & ! ,committees on      
,vet]an's ,affairs & ,heal?1 ,education1
 ,labor1 & ,p5sions ( ! ,s5ate an annual
 report on ! hospital c>e & m$ical      

s]vices furni%$ "u subsection 7a74 ,ea* 
su* report %all expla9 h[ furni%+ su*   
c>e & s]vices "u subsection 7a7 affects 
! foll[+3  7#a7 ,! res\rces ( !         
,dep>tm5t ( ,vet]ans ,affairs4  7#b7 ,! 
co/s incurr$ by vet]ans to receive su*  
c>e & s]vices4  7#c7 ,! am\nt ( "t a    
vet]an mu/ wait to receive hospital c>e 
& s]vices4  7h7 ,critical access        
hospital def9$ ,9 ?is section1 ! t]m    
critical access hospital means a        
hospital designat$ or c]tifi$ z a       
critical access hospital pursuant to    
section #ahbj ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;i-#d74  4  7#b7   
,cl]ical am5dm5t ,! table ( sections at 
! beg9n+ ( su* *apt] is am5d$ by ins]t+ 
aft] ! item relat+ to section #agjc !   
foll[+ new item3  #agjc;,a4 ,c>e at     
critical access hospitals4  4  7b7      
,m$ic>e condition ( p>ticipation        
,section #ahbj7;e7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;i-#d7;e77 is 
am5d$-- 7#a7 9 p>agraph 7#b71 by /rik+  
at ! end &2  7#b7 by r$esignat+ p>agraph

 7#c7 z p>agraph 7#d72 &  7#c7 by ins]t+
 aft] p>agraph 7#b7 ! foll[+ new        
p>agraph3  7#c7 agrees to furni% items &
 s]vices to vet]ans 9 accordance ) !    
agreem5t ent]$ into betwe5 ! ,secret>y &
 ! ,secret>y ( ,vet]ans ,affairs "u     
section #agjc;,a ( title #ch1 ,unit$    
,/ates ,code2 &  4