,i  #aadth ,,congress  #b;d ,session    
,h4 ,r4 #deia  ,,in ,,the ,,house ,,of  
,,representatives  ,february #bc1 #bjaf 
,mr4 ,miller of ,florida introduced the 
following bill2 which was referred to   
the ,committee on ,veterans' ,affairs   
,a ,,bill  ,to amend title #ch1 ,united 
,states ,code1 to authorize the         
,secretary of ,veterans ,affairs to     
enter into agreements with certain      
health care providers to furnish        
hospital care1 medical services1 and    
extended care to veterans4  #a4 ,short  
title ,this ,act may be cited as the    
,department of ,veterans ,affairs       
,purchased ,health ,care ,streamlining  
and ,modernization ,act4  #b4           
,agreements  7a7 ,in general ,subchapter
 ,i of chapter #ag of title #ch1 ,united
 ,states ,code1 is amended by inserting 
after section #agjc the following new   
section3  #agjc;,a4 ,veterans ,care     
,agreements with certain health care    
providers  7a7 ,veterans ,care          
,agreements  7#a7 ,in addition to       

furnishing hospital care1 medical       
services1 or extended care under this   
chapter at facilities of the ,department
 or under contracts or sharing          
agreements entered into pursuant to     
provisions of law other than this       
section1 the ,secretary may furnish such
 care and services to eligible veterans 
through the use of agreements entered   
into under this section by the          
,secretary with eligible providers4     
7#b7 ,the ,secretary may enter into     
,veterans ,care ,agreements under this  
section with eligible providers to      
furnish hospital care1 medical services1
 and extended care to veterans whom the 
,secretary determines that furnishing   
such care and services at facilities of 
the ,department or under contracts or   
sharing agreements under provisions of  
law other than this section is          
impracticable or inadvisable because of 
the medical condition of the veteran1   
the travel involved1 or the nature of   
the care or services required1 or a     

combination of such factors4  7b7       
,veteran eligibility ,eligibility of a  
veteran for care and services under this
 section shall be determined as if such 
care or services were furnished in a    
facility of the ,department1 and        
provisions of this title applicable to  
veterans receiving such care and        
services in a facility of the           
,department shall apply to veterans     
receiving care and services under this  
section4  7c7 ,provider eligibility     
,subject to the certification process   
pursuant to subsection 7d77#a71 a       
provider of hospital care1 medical      
services1 or extended care is eligible  
to enter into a ,veterans ,care         
,agreement under this section if the    
,secretary determines that the provider 
meets each of the following criteria3   
7#a7 ,the gross annual revenue of the   
provider in the year preceding the year 
in which the provider enters into the   
,veterans ,care ,agreement does not     
exceed #aa1jjj1jjj 7as adjusted in a    

manner similar to amounts adjusted      
pursuant to section #ecab of this       
title74  7#b7 ,the provider does not    
otherwise provide such care or services 
to patients pursuant to a contract      
entered into with a department or agency
 of the ,federal ,government4  7#c7 ,the
 provider is-- 7,a7 a provider of       
services that has enrolled and entered  
into a provider agreement under section 
#ahff7;a7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;cc7a772  7,b7 a    
physician or supplier that has enrolled 
and entered into a participation        
agreement under section #ahdb7;h7 of    
such ,act 7#db ,u4,s4,c4 #acieu7h772    
7,c7 a provider of items and services   
receiving payment under a ,state plan   
under title ,,xix of such ,act 7#db     
,u4,s4,c4 #acif et seq47 or a waiver of 
such a plan2  7,d7 an ,aging and        
,disability ,resource ,center1 an area  
agency on aging1 or a ,state agency 7as 
defined in section #ajb of the ,older   
,americans ,act of #aife 7#db ,u4,s4,c4 

#cjjb772 or  7,e7 a center for          
independent living 7as defined in       
section #gjb of the ,rehabilitation ,act
 of #aigc 7#bi ,u4,s4,c4 #gif;a774  7#d7
 ,any additional criteria determined    
appropriate by the ,secretary4  7d7     
,provider certification  7#a7 ,the      
,secretary shall establish a process for
 the certification of eligible providers
 to enter into ,veterans ,care          
,agreements under this section that     
shall1 at a minimum1 set forth the      
following3  7,a7 ,procedures for the    
submission of applications for          
certification and deadlines for actions 
taken by the ,secretary with respect to 
such applications4  7,b7 ,standards and 
procedures for the approval and denial  
of certifications and the revocation of 
certifications4  7,c7 ,procedures for   
assessing eligible providers based on   
the risk of fraud1 waste1 and abuse of  
such providers similar to the level of  
screening under section                 
#ahff7;j77#b77;,b7 of the ,social       

,security ,act 7#db ,u4,s4,c4           
#acie7;j77#b77;,b77 and the standards   
set forth under section #i4ajd of title 
#dh1 ,code of ,federal ,regulations1 or 
any successor regulation4  7,d7         
,requirement for denial or revocation of
 certification if the ,secretary        
determines that the otherwise eligible  
provider is--  7i7 excluded from        
participation in a ,federal health care 
program 7as defined in section          
#aabh;,b7f7 of the ,social ,security    
,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777   
under section #aabh or #aabh;,a of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g and #acbj;a-#g;a72 or  7ii7  
identified as an excluded source on the 
list maintained in the ,system for      
,award ,management1 or any successor    
system4  7,e7 ,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 ,management1 or successor system1
 if the ,secretary determines that such 
exclusion is appropriate4  7#b7 ,to the 
extent practicable1 the ,secretary shall
 establish the procedures under         
paragraph 7#a7 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 7,a7 through 7,e7  
of subsection 7c77#c74  7e7 ,terms of   
,agreements ,the ,secretary shall ensure
 that each ,veterans ,care ,agreement   
include provisions requiring the        
eligible provider to do the following3  
7#a7 ,to accept payment for care and    
services furnished under this section at
 rates established by the ,secretary for
 purposes of this section1 which shall  
be1 to the extent practicable--  7,a7   
the rates paid by the ,united ,states   
for such care to providers of services  
and suppliers under the ,medicare       

program under title ,,xviii of the      
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq472  7,b7 the rates paid by 
the ,united ,states pursuant to the     
,alaska ,fee ,schedule of the           
,department of ,veterans ,affairs2  7,c7
 the rates paid by the ,united ,states  
pursuant to an ,all-,payer ,model       
,agreement under the ,social ,security  
,act2 or  7,d7 the rates paid by the    
,united ,states in a highly rural area  
pursuant to section                     
#aja7;d77#b77;,b77ii77,i7 of the        
,veterans ,access1 ,choice1 and         
,accountability ,act of #bjad 7#ch      
,u4,s4,c4 #agja note74  7#b7 ,to accept 
payment under paragraph 7#a7 as payment 
in full for care and services furnished 
under this section and to not seek any  
payment for such care and services from 
the recipient of such care4  7#c7 ,to   
furnish under this section only the care
 and services authorized by the         
,department under this section unless   
the eligible provider receives prior    

written consent from the ,department to 
furnish care and services outside the   
scope of such authorization4  7#d7 ,to  
bill the ,department for care and       
services furnished under this section in
 accordance with a methodology          
established by the ,secretary for       
purposes of this section4  7#e7 ,not to 
seek to recover or collect from a       
health-plan contract or third party 7as 
those terms are defined in section #agbi
 of this title7 for any care or services
 for which payment is made by the       
,department under this section4  7#f7   
,to provide medical records for veterans
 furnished care and services under this 
section to the ,department in a         
timeframe and format specified by the   
,secretary for purposes of this section1
 except the ,secretary may not require  
that any payment by the ,secretary to   
the eligible provider be contingent on  
such provision of medical records4  7#g7
 ,to meet other such terms and          
conditions1 including quality of care   

assurance standards1 as the ,secretary  
may specify for purposes of this        
section4  7f7 ,exclusion of certain     
,federal contracting provisions  7#a7   
,notwithstanding any other provision of 
law1 the ,secretary may enter into a    
,veterans ,care ,agreement using        
procedures other than competitive       
procedures4  7#b7  7,a7 ,except as      
provided in subparagraph 7,b7 and unless
 otherwise provided in this section1 an 
eligible provider that enters into a    
,veterans ,care ,agreement under this   
section is not subject to1 in the       
carrying out of the agreement1 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   
7#db ,u4,s4,c4 #acie et seq47 or the    
,medicaid program under title ,,xix of  
such ,act 7#db ,u4,s4,c4 #acif et seq47 
are not subject to4  7,b7 ,in addition  
to the provisions of laws covered by    

subparagraph 7,a71 an eligible provider 
shall be subject to the following       
provisions of law3  7i7 ,any applicable 
law regarding integrity1 ethics1 or     
fraud1 or that subject a person to civil
 or criminal penalties4  7ii7 ,section  
#dca of title #ah4  7iii7 ,section #aceb
 of title #ca1 except for the filing    
requirements under subsection 7b7 of    
such section4  7iv7 ,section #dgje or   
#dgab of title #da1 and any other       
applicable law regarding the protection 
of whistleblowers4  7v7 ,section        
#dgjf7;d7 of title #da4  7vi7 ,title    
,,vii of the ,civil ,rights ,act of     
#aifd 7#db ,u4,s4,c4 #bjjj;e et seq47 to
 the same extent as such title applies  
with respect to the eligible provider in
 providing care or services through an  
agreement or arrangement other than     
under a ,veterans ,care ,agreement4     
7,c7 ,an eligible provider that receives
 a payment from the ,federal ,government
 pursuant to a ,veterans ,care          
,agreement shall not be treated as a    

,federal contractor or subcontractor by 
the ,office of ,federal ,contract       
,compliance ,programs of the ,department
 of ,labor based on the work performed  
or actions taken by such eligible       
provider that resulted in the receipt of
 such payments4  7g7 ,termination of    
,veterans ,care agreement  7#a7 ,an     
eligible provider may terminate a       
,veterans ,care ,agreement with the     
,secretary under this section at such   
time and upon such notice to the        
,secretary as the ,secretary may specify
 for purposes of this section4  7#b7    
,the ,secretary may terminate a         
,veterans ,care ,agreement with an      
eligible provider under this section at 
such time and upon such notice to the   
eligible provider as the ,secretary may 
specify for the purposes of this        
section1 if the ,secretary--  7,a7      
determines that the eligible provider   
failed to comply with the provisions of 
the agreement or this section or other  
applicable provision of law2  7,b7 makes

 a revocation pursuant to subsection    
7d77#a77d72  7,c7 ascertains that the   
eligible provider has been convicted of 
a felony or other serious offense under 
,federal or ,state law and determines   
that the continued participation of the 
eligible provider would be detrimental  
to the best interests of veterans of the
 ,department2 or  7,d7 determines that  
it is reasonable to terminate the       
agreement based on the health care needs
 of veterans4  7h7 ,duration2 mandatory 
reviews  7#a7 ,each ,veterans ,care     
,agreement entered into under this      
section shall be for a two-year period  
unless the ,secretary extends the       
agreement pursuant to paragraph         
7#b77;,b74  7#b7  7,a7 ,during the      
#ahj-;day period beginning #edj days    
after the date on which a ,veterans     
,care ,agreement is entered into or     
renewed1 the ,secretary shall review the
 agreement to determine whether it is   
feasible and advisable to instead       
furnish the hospital care1 medical      

services1 or extended care furnished    
under the agreement at facilities of the
 ,department or through contracts or    
sharing agreements entered into under   
authorities other than this section4    
7,b7 ,if the ,secretary determines under
 subparagraph 7,a7 that it is not       
feasible and advisable to instead       
furnish hospital care1 medical services1
 or extended care furnished under a     
,veterans ,care ,agreement at facilities
 of the ,department or through contracts
 or sharing agreements entered into     
under authorities other than this       
section1 the ,secretary--  7i7 shall    
prepare a written memorandum of such    
determination2 and  7ii7 may renew such 
agreement4  7i7 ,disputes  7#a7 ,the    
,secretary shall establish              
administrative procedures for eligible  
providers with which the ,secretary has 
entered into a ,veterans ,care          
,agreement to present any dispute       
arising under or related to the         
agreement4  7#b7 ,before using any      

dispute resolution mechanism under      
chapter #ga of title #da with respect to
 a dispute arising under a ,veterans    
,care ,agreement under this section1 an 
eligible provider must first exhaust the
 administrative procedures established  
by the ,secretary under paragraph 7#a74 
7j7 ,annual reports ,not later than     
,october #a of the year following the   
fiscal year in which the ,secretary     
first enters into a ,veterans ,care     
,agreement1 and each year thereafter1   
the ,secretary shall submit to the      
appropriate congressional committees an 
annual report that includes--  7#a7 a   
list of all ,veterans ,care ,agreements 
entered into as of the date of the      
report2 and  7#b7 summaries of each     
determination made by the ,secretary    
under subsection 7h77#b7 during the     
fiscal year covered by the report4  7k7 
,quality of care ,in carrying out this  
section1 the ,secretary shall use the   
quality of care standards set forth or  
used by the ,centers for ,medicare      

,medicaid ,services4  7l7 ,delegation   
,the ,secretary may delegate the        
authority to enter into or terminate a  
,veterans ,care ,agreement1 or to make a
 determination described in subsection  
7h77#b71 at a level not below the       
,assistant ,deputy ,under ,secretary for
 ,health for ,community ,care4  7m7     
,sunset ,the ,secretary may not enter   
into or renew a ,veterans ,care         
,agreement under this section after the 
date that is five years after the       
enactment of this ,act4  7n7            
,definitions ,in this section3 7#a7 ,the
 term appropriate congressional         
committees means--  7,a7 the ,committees
 on ,veterans' ,affairs of the ,house of
 ,representatives and the ,senate2 and  
7,b7 the ,committees on ,appropriations 
of the ,house of ,representatives and   
the ,senate4  7#b7 ,the term eligible   
provider means a provider of hospital   
care1 medical services1 or extended care
 that the ,secretary determines is      
eligible to enter into ,veterans ,care  

,agreements under subsection 7c74  7#c7 
,the term ,veterans ,care ,agreement    
means an agreement entered into by the  
,secretary with an eligible provider    
under subsection 7a77#a74  4  7b7       
,clerical amendment ,the table of       
sections at the beginning of chapter #ag
 of such title is amended by inserting  
after the item related to section #agjc 
the following new item3  #agjc;,a4      
,veterans ,care ,agreements with certain
 health care providers4  4  7c7         
,regulations ,not later than one year   
after the date of the enactment of this 
,act1 the ,secretary of ,veterans       
,affairs shall prescribe interim final  
regulations to implement section        
#agjc;,a of title #ch1 ,united ,states  
,code1 as added by subsection 7a71 and  
publish such regulations in the ,federal
 ,register4