,,ii  #aad? ,,congress  #a/ ,session    
,s4 #bjjj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,augu/ #e1 #bjae,mr4   
,hoev5 7= himself & ,mr4 ,man*97        
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,vet]ans' ,affairs  ,a ,,bill  ,to am5d 
title #ch1 ,unit$ ,/ates ,code1 to all[ 
! ,secret>y ( ,vet]ans ,affairs to ent] 
into c]ta9 agreem5ts ) non-,dep>tm5t (  
,vet]ans ,affairs heal? c>e provid]s if 
! ,secret>y is n feasibly able to       
provide heal? c>e 9 facilities ( !      
,dep>tm5t or ?r\gh contracts or %>+     
agreem5ts1 & = o!r purposes4  #a4 ,%ort 
title ,?is ,act may be cit$ z ! ,vet]ans
 ,access to ,long ,t]m ,c>e & ,heal?    
,s]vices ,act4  #b4 ,purpose ,! purpose 
( ?is ,act is-- 7#a7 to ma9ta9 ! access 
( vet]ans to high-quality hospital c>e1 
m$ical s]vices1 & ext5d$ c>e if t c>e is
 n available directly f ! ,dep>tm5t (   
,vet]ans ,affairs2  7#b7 to cont9ue to  
all[ ! use by ! ,dep>tm5t ( agreem5ts   
cov]$ by ! ,f$]al ,acquisition          

,regulation & agreem5ts t are n cov]$ by
 su* regulation1 simil> to ^? agreem5ts 
us$ "u ! orig9al ,m$ic>e fee-=-s]vice   
program 7,m$ic>e ,p>ts ,a & ,b71 if x is
 n practicable to contract = ! c>e ne$$ 
by vet]ans ?r\gh an agreem5t cov]$ by   
su* regulation2  7#c7 to address ! fact 
t individual heal? c>e provid]s1        
especially small] provid]s 9 rural      
areas1 may n be will+ to accept vet]ans 
z pati5ts :5 do+ s w\ld require !       
significant "t & adm9i/rative           
requirem5ts 9 connection ) ent]+ into   
agreem5ts ) ! ,dep>tm5t t are cov]$ by  
su* regulation2  7#d7 to address !      
defici5cies 9 curr5t law reg>d+         
agreem5ts ent]$ into by ! ,dep>tm5t t h 
rais$ legal issues2 &  7#e7 to ensure t 
agreem5ts t are n cov]$ by su*          
regulation include robu/ t]ms &         
conditions t address ! quality ( heal?  
c>e = vet]ans1 ov]sight ( ! provision ( 
su* heal? c>e1 & protections = taxpay]s4
  #c4 ,au?orization ( agreem5ts betwe5 !
 ,dep>tm5t ( ,vet]ans ,affairs &        

non-,dep>tm5t heal? c>e provid]s  7a7 ,9
 g5]al ,sub*apt] ,i ( *apt] #ag ( title 
#ch1 ,unit$ ,/ates ,code1 is am5d$ by   
add+ aft] section #agjc ! foll[+ new    
section3  #agjc;,a4 ,vet]ans ,c>e       
,agreem5ts ) c]ta9 heal? c>e provid]s   
7a7 ,agreem5ts ,to ,furni% ,c>e  7#a7   
,if ! ,secret>y is n feasibly able to   
furni% hospital c>e1 m$ical s]vices1 or 
ext5d$ c>e "u ?is *apt] at facilities ( 
! ,dep>tm5t or "u contracts or %>+      
agreem5ts ent]$ into "u au?orities o!r  
?an ?is section1 ! ,secret>y may furni% 
su* c>e & s]vices by ent]+ into         
agreem5ts "u ?is section ) eligible     
provid]s t are c]tifi$ "u subsection    
7c74 ,an agreem5t ent]$ into "u ?is     
section may be ref]r$ to z a ,vet]ans   
,c>e ,agreem5t4  7#b7 ,! ,secret>y is n 
feasibly able to furni% c>e or s]vices z
 describ$ 9 p>agraph 7#a7 if ! ,secret>y
 det]m9es t ! m$ical condition ( !      
vet]an1 ! travel involv$1 ! nature ( !  
c>e or s]vices requir$1 or a comb9ation 
( ^? factors make ! use ( facilities ( !

 ,dep>tm5t1 contracts1 or %>+ agreem5ts 
impracticable or inadvisable4  7#c7     
,eligibility ( a vet]an "u ?is section =
 ! c>e or s]vices describ$ 9 p>agraph   
7#a7 %all be det]m9$ z if su* c>e or    
s]vices 7 furni%$ 9 a facility ( !      
,dep>tm5t & provisions ( ?is title      
applicable to vet]ans receiv+ su* c>e or
 s]vices 9 a facility ( ! ,dep>tm5t %all
 apply to vet]ans receiv+ su* c>e or    
s]vices "u ?is section4  7b7 ,eligible  
provid]s ,= purposes ( ?is section1 an  
eligible provid] is "o ( ! foll[+3 7#a7 
,a provid] ( s]vices t has enroll$ &    
ent]$ into a provid] agreem5t "u section
 #ahff7;a7 ( ! ,social ,security ,act   
7#db ,u4,s4,c4 #acie;cc7a774  7#b7 ,a   
physician or suppli] t has enroll$ &    
ent]$ into a p>ticipation agreem5t "u   
section #ahdb7;h7 ( su* ,act 7#db       
,u4,s4,c4 #acieu7h774  7#c7 ,a provid] (
 items & s]vices receiv+ paym5t "u a    
,/ate plan "u title ,,xix ( su* ,act    
7#db ,u4,s4,c4 #acif et seq47 or a waiv]
 ( su* a plan4  7#d7 ,a provid] t is--  

7,a7 an ,ag+ & ,disability ,res\rce     
,c5t]1 an area ag5cy on ag+1 or a ,/ate 
ag5cy 7z def9$ 9 section #ajb ( ! ,old] 
,am]icans ,act ( #aife 7#db ,u4,s4,c4   
#cjjb772 or  7,b7 a c5t] = indep5d5t    
liv+ 7z def9$ 9 section #gjb ( !        
,rehabilitation ,act ( #aigc 7#bi       
,u4,s4,c4 #gif;a774  7#e7 ,su* o!r heal?
 c>e provid]s z ! ,secret>y consid]s    
appropriate = purposes ( ?is section4   
7c7 ,c]tification ( eligible provid]s   
7#a7 ,! ,secret>y %all e/abli% a process
 = ! c]tification ( eligible provid]s "u
 ?is section t %all1 at a m9imum1 set =?
 ! foll[+4  7,a7 ,proc$ures = !         
submittal ( applications = c]tification 
& deadl9es = actions tak5 by ! ,secret>y
 ) respect to su* applications4  7,b7   
,/&>ds & proc$ures = approval & d5ial ( 
c]tification1 duration ( c]tification1  
revocation ( c]tification1 &            
rec]tification4  7,c7 ,proc$ures =      
assess+ eligible provid]s bas$ on ! risk
 ( fraud1 wa/e1 & abuse ( su* provid]s  
simil> to ! level ( scre5+ "u section   

#ahff7;j77#b77;,b7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4                    
#acie;cc7j77#b77;,b77 & ! /&>ds set =?  
"u section #i4ajd ( title #dh1 ,code (  
,f$]al ,regulations1 or any successor   
regulation4  7#b7 ,! ,secret>y %all d5y 
or revoke c]tification to an eligible   
provid] "u ?is subsection if ! ,secret>y
 det]m9es t ! eligible provid] is       
curr5tly--  7,a7 exclud$ f p>ticipation 
9 a ,f$]al heal? c>e program 7z def9$ 9 
section #aabh;,b7f7 ( ! ,social         
,security ,act 7#db ,u4,s4,c4           
#acbj;a-#g;b7f777 "u section #aabh or   
#aabh;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;a-#g & #acbj;a-#g;a72  
or  7,b7 id5tifi$ z an exclud$ s\rce on 
! li/ ma9ta9$ 9 ! ,sy/em = ,aw>d        
,managem5t1 or any successor sy/em4  7d7
 ,t]ms ( agreem5ts ,ea* agreem5t ent]$  
into ) an eligible provid] "u ?is       
section %all include provisions requir+ 
! eligible provid] to d ! foll[+3  7#a7 
,to accept paym5t = c>e & s]vices       
furni%$ "u ?is section at rates e/abli%$

 by ! ,secret>y = purposes ( ?is        
section1 :i* %all be1 to ! ext5t        
practicable1 ! rates paid by ! ,unit$   
,/ates = su* c>e & s]vices to provid]s (
 s]vices & suppli]s "u ! ,m$ic>e program
 "u title ,,xviii ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie et seq474     
7#b7 ,to accept paym5t "u p>agraph 7#a7 
z paym5t 9 full = c>e & s]vices furni%$ 
"u ?is section & to n seek any paym5t = 
su* c>e & s]vices f ! recipi5t ( su* c>e
 & s]vices4  7#c7 ,to furni% "u ?is     
section only ! c>e & s]vices au?oriz$ by
 ! ,dep>tm5t "u ?is section unless !    
eligible provid] receives prior writt5  
cons5t f ! ,dep>tm5t to furni% c>e or   
s]vices outside ! scope ( su*           
au?orization4  7#d7 ,to bill ! ,dep>tm5t
 = c>e & s]vices furni%$ "u ?is section 
9 accordance ) a me?odology e/abli%$ by 
! ,secret>y = purposes ( ?is section4   
7#e7 ,n to seek to recov] or collect f a
 heal?-plan contract or ?ird p>ty1 z ^? 
t]ms are def9$ 9 section #agbi ( ?is    
title1 = any c>e or s]vices = :i* paym5t

 is made by ! ,dep>tm5t "u ?is section4 
7#f7 ,to provide m$ical records =       
vet]ans furni%$ c>e or s]vices "u ?is   
section to ! ,dep>tm5t 9 a timeframe &  
=mat specifi$ by ! ,secret>y = purposes 
( ?is section4  7#g7 ,to meet su* o!r   
t]ms & conditions1 includ+ quality ( c>e
 assurance /&>ds1 z ! ,secret>y may     
specify = purposes ( ?is section4  7e7  
,t]m9ation ( agreem5ts  7#a7 ,an        
eligible provid] may t]m9ate an agreem5t
 ) ! ,secret>y "u ?is section at su* "t 
& ^u su* notice to ! ,secret>y z !      
,secret>y may specify = purposes ( ?is  
section4  7#b7 ,! ,secret>y may t]m9ate 
an agreem5t ) an eligible provid] "u ?is
 section at su* "t & ^u su* notice to ! 
eligible provid] z ! ,secret>y may      
specify = purposes ( ?is section1 if !  
,secret>y--  7,a7 det]m9es t ! eligible 
provid] fail$ to comply sub/antially ) !
 provisions ( ! agreem5t or ) !         
provisions ( ?is section & ! regulations
 prescrib$ !reund]2  7,b7 det]m9es t !  
eligible provid] is-- 7i7 exclud$ f     

p>ticipation 9 a ,f$]al heal? c>e       
program 7z def9$ 9 section #aabh;,b7f7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acbj;a-#g;b7f777 "u section #aabh or  
#aabh;,a ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acbj;a-#g & #acbj;a-#g;a72  
or  7ii7 id5tifi$ z an exclud$ s\rce on 
! li/ ma9ta9$ 9 ! ,sy/em = ,aw>d        
,managem5t1 or any successor sy/em2     
7,c7 asc]ta9s t ! eligible provid] has  
be5 convict$ ( a felony or o!r s]i\s    
(f5se "u ,f$]al or ,/ate law & det]m9es 
t ! cont9u$ p>ticipation ( ! eligible   
provid] w\ld be detrim5tal to ! be/     
int]e/s ( vet]ans or ! ,dep>tm5t2 or    
7,d7 det]m9es t x is reasonable to      
t]m9ate ! agreem5t bas$ on ! heal? c>e  
ne$s ( a vet]an or vet]ans4  7f7        
,p]iodic review ( c]ta9 agreem5ts  7#a7 
,n less frequ5tly ?an once e two ye>s1 !
 ,secret>y %all review ea* ,vet]ans ,c>e
 ,agreem5t ( mat]ial size ent]$ into    
dur+ ! two-ye> p]iod prec$+ ! review to 
det]m9e :e!r x is feasible & advisable  
to furni% ! hospital c>e1 m$ical        

s]vices1 or ext5d$ c>e furni%$ "u su*   
agreem5t at facilities ( ! ,dep>tm5t or 
?r\gh contracts or %>+ agreem5ts ent]$  
into "u au?orities o!r ?an ?is section4 
7#b7 7,a7 ,subject to subp>agraph 7,b71 
a ,vet]ans ,c>e ,agreem5t is ( mat]ial  
size z det]m9$ by ! ,secret>y = purposes
 ( ?is section4  7,b7 ,a ,vet]ans ,c>e  
,agreem5t ent]$ into aft] ,septemb] #cj1
 #bjaf1 = ! pur*ase ( ext5d$ c>e s]vices
 is ( mat]ial size if ! pur*ase ( su*   
s]vices "u ! agreem5t exce$s #a1jjj1jjj 
annually4 ,! ,secret>y may adju/ su*    
am\nt to acc\nt = *anges 9 ! co/ ( heal?
 c>e bas$ ^u recogniz$ heal? c>e m>ket  
surveys & o!r available data & %all     
publi% any su* adju/m5ts 9 ! ,f$]al     
,regi/]4  7g7 ,treatm5t ( c]ta9 laws    
7#a7 ,an agreem5t "u ?is section may be 
ent]$ into )\t reg>d to any law t w\ld  
require ! ,secret>y to use competitive  
proc$ures 9 select+ ! p>ty ) :i* to ent]
 into ! agreem5t4  7#b7 7,a7 ,except z  
provid$ 9 subp>agraph 7,b7 & unless     
o!rwise provid$ 9 ?is section or        

regulations prescrib$ pursuant to ?is   
section1 an eligible provid] t ent]s    
into an agreem5t "u ?is section is n    
subject to1 9 ! c>ry+ out ( ! agreem5t1 
any law t an eligible provid] describ$ 9
 subsection 7b77#a71 7b77#b71 or 7b77#c7
 is n subject to "u ! orig9al ,m$ic>e   
fee-=-s]vice program "u p>ts ,a & ,b (  
title ,,xviii ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie et seq47 or !     
,m$icaid program "u title ,,xix ( su*   
,act 7#db ,u4,s4,c4 #acif et seq474     
7,b7 ,! exclusion "u subp>agraph 7,a7   
does n apply to laws reg>d+ integrity1  
e?ics1 fraud1 or t subject a p]son to   
civil or crim9al p5alties4  7#c7 ,title 
,,vii ( ! ,civil ,rights ,act ( #aifd   
7#db ,u4,s4,c4 #bjjj;e et seq47 %all    
apply ) respect to an eligible provid] t
 ent]s into an agreem5t "u ?is section  
to ! same ext5t z su* title applies )   
respect to ! eligible provid] 9 provid+ 
c>e or s]vices ?r\gh an agreem5t or     
arrangem5t o!r ?an "u ?is section4  7h7 
,monitor+ ( quality ( c>e ,! ,secret>y  

%all e/abli% a sy/em or sy/ems1 consi/5t
 ) survey & c]tification proc$ures us$  
by ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices
 & ,/ate survey ag5cies to ! ext5t      
practicable--  7#a7 to monitor ! quality
 ( c>e & s]vices furni%$ to vet]ans "u  
?is section2 &  7#b7 to assess ! quality
 ( c>e & s]vices furni%$ by an eligible 
provid] = purposes ( det]m9+ :e!r to    
r5ew an agreem5t "u ?is section ) !     
eligible provid]4  7i7 ,dispute         
resolution  7#a7 ,! ,secret>y %all      
e/abli% adm9i/rative proc$ures =        
eligible provid]s ) :i* ! ,secret>y has 
ent]$ an agreem5t "u ?is section to     
pres5t any dispute aris+ "u or relat$ to
 ! agreem5t4  7#b7 ,be=e us+ any dispute
 resolution me*anism "u *apt] #ga (     
title #da ) respect to a dispute aris+  
"u an agreem5t "u ?is section1 an       
eligible provid] mu/ fir/ exhau/ !      
adm9i/rative proc$ures e/abli%$ by !    
,secret>y "u p>agraph 7#a74  4  7b7     
,regulations ,! ,secret>y ( ,vet]ans    
,affairs %all prescribe an int]im f9al  

rule to c>ry out section #agjc;,a ( su* 
title1 z add$ by subsection 7a71 n lat] 
?an "o ye> aft] ! date ( ! enactm5t (   
?is ,act4  7c7 ,cl]ical am5dm5t ,! table
 ( sections at ! beg9n+ ( *apt] #ag (   
su* title is am5d$ by ins]t+ aft] ! item
 relat$ to section #agjc ! foll[+ new   
item3  #agjc;,a4 ,vet]ans ,c>e          
,agreem5ts ) c]ta9 heal? c>e provid]s4  
4  #d4 ,modification ( au?ority to ent] 
into agreem5ts to provide nurs+ home c>e
  7a7 ,use ( agreem5ts  7#a7 ,9 g5]al   
,p>agraph 7#a7 ( section #agde7;a7 (    
title #ch1 ,unit$ ,/ates ,code1 is      
am5d$1 9 ! matt] prec$+ subp>agraph     
7,a71 by /rik+ a contract 7or agreem5t  
"u section #agbj7;c77#a7 ( ?is title7 & 
ins]t+ an agreem5t4  7#b7 ,paym5t       
,p>agraph 7#b7 ( su* section is am5d$ by
 /rik+ contract 7or agreem5t7 ea* place 
x appe>s & ins]t+ agreem5t4  7b7        
,exclusion ( c]ta9 ,f$]al contract+     
provisions ,su* section is am5d$ by add+
 at ! end ! foll[+ new p>agraph3  7#d7  
7,a7 ,an agreem5t "u ?is section may be 

ent]$ into )\t reg>d to any law t w\ld  
require ! ,secret>y to use competitive  
proc$ures 9 select+ ! p>ty ) :i* to ent]
 into ! agreem5t4  7,b7 7i7 ,except z   
provid$ 9 clause 7ii7 & unless o!rwise  
provid$ 9 ?is section or regulations    
prescrib$ pursuant to ?is section1 a    
,/ate home t ent]s into an agreem5t "u  
?is section is n subject to1 9 ! c>ry+  
out ( ! agreem5t1 any law t a provid]   
describ$ 9 subp>agraph 7,d7 is n subject
 to "u ! orig9al ,m$ic>e fee-=-s]vice   
program "u p>ts ,a & ,b ( title ,,xviii 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #acie et seq47 or ! ,m$icaid  
program "u title ,,xix ( su* ,act 7#db  
,u4,s4,c4 #acif et seq474  7ii7 ,!      
exclusion "u clause 7i7 does n apply to 
laws reg>d+ integrity1 e?ics1 fraud1 or 
t subject a p]son to civil or crim9al   
p5alties4  7,c7 ,title ,,vii ( ! ,civil 
,rights ,act ( #aifd 7#db ,u4,s4,c4     
#bjjj;e et seq47 %all apply ) respect to
 any ,/ate home t ent]s into an agreem5t
 "u ?is section4  7,d7 ,a provid]       

describ$ 9 ?is subp>agraph is "o ( !    
foll[+3 7i7 ,a provid] ( s]vices t has  
enroll$ & ent]$ into a provid] agreem5t 
"u section #ahff7;a7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acie;cc7a774  7ii7 ,a physician or     
suppli] t has enroll$ & ent]$ into a    
p>ticipation agreem5t "u section        
#ahdb7;h7 ( su* ,act 7#db ,u4,s4,c4     
#acieu7h774  7iii7 ,a provid] ( items & 
s]vices receiv+ paym5t "u a ,/ate plan  
"u title ,,xix ( su* ,act 7#db ,u4,s4,c4
 #acif et seq47 or a waiv] ( su* a plan4
  4  7c7 ,effective date ,! am5dm5ts    
made by ?is section %all apply to nurs+ 
home c>e provid$ "u section #agde ( su* 
title on & aft] ! date t is #cj days    
aft] ! date ( ! enactm5t ( ?is ,act4