,,ii #aadth ,,congress #b;d ,session ,s4 #bfcc ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #c1 #bjaf ,mr4 ,tester 7for himself1 ,mr4 ,blumenthal1 ,mr4 ,bennet1 ,mr4 ,udall1 ,mr4 ,brown1 and ,ms4 ,heitkamp7 introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,a ,,bill ,to improve the ability of the ,secretary of ,veterans ,affairs to provide health care to veterans through non-,department health care providers1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,improving ,veterans ,access to ,care in the ,community ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,,title ,i--,improvement of access of veterans to non-,department care ,sec4 #aja4 ,improvement of access of veterans to health care through establishment of ,veterans ,choice ,program4 ,sec4 #ajb4 ,expansion of reimbursement of veterans for emergency treatment and urgent care4 ,sec4 #ajc4 ,termination of certain provisions authorizing care to veterans through non-,department of ,veterans ,affairs providers4 ,,title ,,ii--,authority to pay for non-,department care ,sec4 #bja4 ,authorization of agreements between the ,department of ,veterans ,affairs and non-,department health care providers4 ,sec4 #bjb4 ,modification of authority to enter into agreements with ,state homes to provide nursing home care4 ,sec4 #bjc4 ,requirement for advance appropriations for the ,care in the ,community account of the ,department of ,veterans ,affairs4 ,sec4 #bjd4 ,annual transfer of amounts within ,department of ,veterans ,affairs to pay for health care from non-,department providers4 ,sec4 #bje4 ,elimination of requirement to act as secondary payer for care relating to non-service-connected disabilities under ,choice ,program4 ,sec4 #bjf4 ,authorization of use of certain amounts appropriated to the ,veterans ,choice ,fund for other non-,department of ,veterans ,affairs care4 ,sec4 #bjg4 ,modification of process through which ,department of ,veterans ,affairs records obligations for non-,department care4 ,,title ,,iii--,other health care matters ,sec4 #cja4 ,treatment of ,department of ,veterans ,affairs as participating provider for recovery of costs of certain medical care4 ,sec4 #cjb4 ,primary care providers for veterans enrolled in patient enrollment system of ,department of ,veterans ,affairs4 ,i ,improvement of access of veterans to non-,department care #aja4 ,improvement of access of veterans to health care through establishment of ,veterans ,choice ,program 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 ,choice ,program 7a7 ,in general 7#a7 ,the ,secretary shall enter into contracts or agreements under sections #agjc;,b1 #haaa1 and #haec of this title with eligible providers to furnish hospital care and medical services under this chapter to eligible veterans4 ,the provision of hospital care and medical services under this section may be referred to as the ,veterans ,choice ,program4 7#b7 ,hospital care and medical services shall be furnished under this section to an eligible veteran at the election of the veteran4 7#c7 7,a7 ,an eligible veteran who makes an election under paragraph 7#b7 to receive hospital care or medical services under this section may select a provider of such care or services from among the health care providers specified in subsection 7c77#b7 that are accessible to the veteran4 7,b7 ,the ,secretary may not direct an eligible veteran to a provider that is not the eligible provider selected by the veteran under subparagraph 7,a74 7b7 ,eligible veterans ,a veteran is an eligible veteran for purposes of this section if-- 7#a7 the veteran is enrolled in the patient enrollment system of the ,department established and operated under section #agje of this title2 and 7#b7 7,a7 the veteran is unable to schedule an appointment for the receipt of hospital care or medical services from a health care provider of the ,department within the lesser of-- 7i7 the wait-time goals of the ,veterans ,health ,administration for such care or services1 as determined by the ,secretary2 or 7ii7 a period determined by a health care provider of the ,department to be clinically necessary for the receipt of such care or services2 7,b7 the veteran does not reside within #dj miles driving distance from a medical facility of the ,department1 including a community-based outpatient clinic1 with a full-time primary care provider2 7,c7 the veteran faces an excessive burden in accessing hospital care or medical services from a medical facility of the ,department due to-- 7i7 geographical challenges2 7ii7 environmental factors2 7iii7 a medical condition of the veteran that affects the ability to travel2 or 7iv7 such other factors as determined by the ,secretary2 7,d7 the hospital care or medical services sought by the veteran are not provided at a medical facility of the ,department that is accessible to the veteran2 7,e7 the veteran is enrolled in the pilot program under section #djc of the ,veterans' ,mental ,health and ,other ,care ,improvements ,act of #bjjh 7,public ,law #aaj-chg2 #ch ,u4,s4,c4 #agjc note7 as of the date of the enactment of the ,improving ,veterans ,access to ,care in the ,community ,act2 7,f7 the veteran is assigned a primary care provider under section #agje;,a of this title that is not a health care provider of the ,department2 and 7,g7 there is a compelling reason1 as determined by the ,secretary1 that the veteran needs to receive hospital care or medical services from a medical facility other than a medical facility of the ,department4 7c7 ,eligible providers 7#a7 ,a health care provider is an eligible provider for purposes of this section if the health care provider is a health care provider specified in paragraph 7#b7 and meets standards established by the ,secretary for purposes of this section1 including standards relating to education1 certification1 licensure1 training1 and employment history4 7#b7 ,the health care providers specified in this paragraph are the following3 7,a7 ,any health care provider that is participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including any physician furnishing services under such program4 7,b7 ,any health care provider of a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7,c7 ,any health care provider of the ,department of ,defense4 7,d7 ,any health care provider of the ,indian ,health ,service4 7,e7 ,any health care provider of an academic affiliate of the ,department of ,veterans ,affairs4 7,f7 ,any health care provider of a health system established to serve ,alaska ,natives4 7,g7 ,any other health care provider that meets criteria established by the ,secretary for purposes of this section4 7#c7 ,to promote the provision of high-quality and high-value health care under this section1 the ,secretary may develop a tiered provider network of eligible providers based on criteria established by the ,secretary for purposes of this section4 7d7 ,reimbursement rates 7#a7 ,the ,secretary shall be primarily responsible for the payment of costs associated with hospital care and medical services furnished under this section4 7#b7 ,to the extent practicable1 the rates paid by the ,secretary for hospital care and medical services furnished under this section-- 7,a7 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 or services2 and 7,b7 shall incorporate the use of value-based reimbursement models to promote the provision of high-quality care4 7e7 ,prompt payment standard 7#a7 ,an eligible provider that seeks reimbursement for hospital care or medical services furnished under this section shall submit to the ,secretary a claim for reimbursement not later than #ahj days after furnishing such care or services4 7#b7 ,notwithstanding any other provision of law1 the ,secretary shall reimburse an eligible provider for hospital care or medical services furnished under this section-- 7,a7 in the case of a clean claim submitted to the ,secretary on paper1 not later than #de calendar days after receiving the claim2 or 7,b7 in the case of a clean claim submitted to the ,secretary electronically1 not later than #cj calendar days after receiving the claim4 7#c7 7,a7 ,if the ,secretary denies a claim submitted by an eligible provider under paragraph 7#a71 the ,secretary shall notify the eligible provider of the reason for denying the claim and the additional information1 if any1 that may be required to process the claim-- 7i7 in the case of a clean claim submitted to the ,secretary on paper1 not later than #de calendar days after receiving the claim2 or 7ii7 in the case of a clean claim submitted to the ,secretary electronically1 not later than #cj calendar days after receiving the claim4 7,b7 ,upon receipt by the ,secretary of additional information specified under subparagraph 7,a7 relating to a claim1 the ,secretary shall pay1 deny1 or otherwise adjudicate the claim1 as appropriate1 not later than #cj calendar days after receiving such information4 7#d7 7,a7 ,if the ,secretary has not reimbursed an eligible provider or denied a claim for reimbursement by the eligible provider under this subsection during the appropriate period specified in this subsection1 such claim shall be considered overdue4 7,b7 ,if a valid claim for reimbursement by an eligible provider is considered overdue under subparagraph 7,a71 in addition to the amount the ,secretary owes the eligible provider under the claim1 the ,secretary shall owe the eligible provider an interest penalty amount that shall-- 7i7 be prorated daily2 7ii7 accrue from the date the payment was overdue2 7iii7 be payable at the time the claim is paid2 and 7iv7 be computed at the rate of interest established by the ,secretary of the ,treasury1 and published in the ,federal ,register1 for interest payments under subsections 7a77#a7 and 7b7 of section #gaji of title #da that is in effect at the time the ,secretary accrues the obligation to pay the interest penalty amount4 7#e7 7,a7 ,if the ,secretary overpays an eligible provider for hospital care or medical services furnished under this section1 the ,secretary shall deduct the amount of any overpayment from payments due to the eligible provider after the date of such overpayment4 7,b7 7i7 ,before deducting any amount from a payment to an eligible provider under subparagraph 7,a71 the ,secretary shall ensure that the eligible provider is provided an opportunity-- 7,i7 to dispute the existence or amount of any overpayment owed to the ,department2 and 7,,ii7 to request a compromise with respect to any such overpayment4 7ii7 ,the ,secretary may not make any deduction from a payment to an eligible provider under subparagraph 7,a7 unless the ,secretary has made reasonable efforts to notify the eligible provider of the rights of the eligible provider under subclauses 7,i7 and 7,,ii7 of clause 7i74 7iii7 ,upon receiving a dispute under subclause 7,i7 of clause 7i7 or a request under subclause 7,,ii7 of such clause1 the ,secretary shall make a determination with respect to such dispute or request before making any deduction under subparagraph 7,a7 unless the time required to make such a determination would jeopardize the ability of the ,secretary to recover the full amount owed to the ,department4 7#f7 ,notwithstanding any other provision of law-- 7,a7 the authority of the ,secretary to make deductions under paragraph 7#e7 or take any other action for the purpose of collecting a debt owed to the ,united ,states under this section shall not be subject to any limitation with respect to the time for bringing civil actions or for commencing administrative proceedings2 and 7,b7 the ,secretary may1 except in the case of a fraudulent claim1 false claim1 or misrepresented claim1 compromise any claim of an amount owed to the ,united ,states under this section4 7#g7 ,this subsection shall apply only to payments made on a claims basis and not to capitation or other forms of periodic payments to eligible providers4 7f7 ,cost sharing 7#a7 ,the ,secretary shall require an eligible veteran to pay a copayment for the receipt of hospital care or medical services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services under this chapter at a medical facility of the ,department or from a health care provider of the ,department4 7#b7 ,the amount of any copayment charged to an eligible veteran under paragraph 7#a7 for the receipt of hospital care or medical services under this section may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services under this chapter at a medical facility of the ,department or from a health care provider of the ,department4 7g7 ,coordination of care and services ,the ,secretary shall establish such procedures to promote coordination of care and the sharing of health information as the ,secretary considers appropriate to carry out this section4 7h7 ,regulations ,the ,secretary shall prescribe regulations to carry out this section4 7i7 ,effective date ,the ,secretary may not furnish hospital care or medical services under this section before the date specified in section #aja7p77#b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7j7 ,definitions ,in this section3 7#a7 ,the term ,alaska ,native means a person who is a member of any ,native village1 ,village ,corporation1 or ,regional ,corporation1 as those terms are defined in section #c of the ,alaska ,native ,claims ,settlement ,act 7#dc ,u4,s4,c4 #afjb74 7#b7 ,the term clean claim means a claim submitted-- 7,a7 to the ,secretary by an eligible provider for purposes of payment by the ,secretary of expenses for hospital care or medical services furnished under this section2 7,b7 that contains substantially all of the required elements necessary for accurate adjudication1 without requiring additional information from the eligible provider2 and 7,c7 in such format as may be prescribed by the ,secretary for purposes of paying claims for hospital care or medical services furnished under this section4 7#c7 ,the term fraudulent claim-- 7,a7 means a claim by a health care provider for reimbursement under this section that includes an intentional and deliberate misrepresentation of a material fact or facts that is intended to induce the ,secretary to pay an amount that was not legally owed to the provider2 and 7,b7 does not include a claim in which a misrepresentation is made in reliance on a good faith interpretation by a health care provider of the utilization1 medical necessity1 coding1 or billing requirements of the ,secretary4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agjc the following new item3 #agjc;,a4 ,veterans ,choice ,program4 4 #ajb4 ,expansion of reimbursement of veterans for emergency treatment and urgent care 7a7 ,in general ,section #agbe of title #ch1 ,united ,states ,code1 is amended to read as follows3 #agbe4 ,reimbursement for emergency treatment and urgent care 7a7 ,in general 7#a7 ,subject to the provisions of this section1 the ,secretary shall reimburse a veteran described in subsection 7b7 for the reasonable value of emergency treatment or urgent care furnished the veteran in a non-,department facility4 7#b7 ,in any case in which reimbursement of a veteran is authorized under paragraph 7#a71 the ,secretary may1 in lieu of reimbursing the veteran1 make payment of the reasonable value of the furnished emergency treatment or urgent care directly-- 7,a7 to the hospital or other health care provider that furnished the treatment or care2 or 7,b7 to the person or organization that paid for such treatment or care on behalf of the veteran4 7b7 ,eligibility ,a veteran described in this subsection is an individual who-- 7#a7 is enrolled in the patient enrollment system of the ,department established and operated under section #agje of this title2 and 7#b7 has received care under this chapter during the #bd-month period preceding the furnishing of the emergency treatment or urgent care for which reimbursement is sought under this section4 7c7 ,emergency transportation ,notwithstanding section #aaa of this title1 reimbursement of emergency treatment or urgent care under this section shall include reimbursement for the reasonable value of emergency transportation4 7d7 ,responsibility for payment ,the ,secretary shall be primarily responsible for reimbursing or otherwise paying the reasonable value of emergency treatment or urgent care under this section4 7e7 ,limitations on payment 7#a7 ,the ,secretary1 in accordance with regulations prescribed by the ,secretary for purposes of this section1 shall-- 7,a7 establish the maximum amount payable under subsection 7a72 and 7,b7 delineate the circumstances under which such payments may be made1 including such requirements on requesting reimbursement as the ,secretary may establish4 7#b7 7,a7 ,payment by the ,secretary under this section on behalf of a veteran to a provider of emergency treatment or urgent care shall1 unless rejected and refunded by the provider within #cj days of receipt-- 7i7 constitute payment in full for the emergency treatment or urgent care provided2 and 7ii7 extinguish any liability on the part of the veteran for that treatment or care4 7,b7 ,neither the absence of a contract or agreement between the ,secretary and a provider of emergency treatment or urgent care nor any provision of a contract1 agreement1 or assignment to the contrary shall operate to modify1 limit1 or negate the requirements of subparagraph 7,a74 7,c7 ,a provider of emergency treatment or urgent care may not seek to recover from any third party the cost of emergency treatment or urgent care for which the provider has received payment from the ,secretary under this section4 7f7 ,recovery ,the ,united ,states has the right to recover or collect reasonable charges for emergency treatment or urgent care furnished under this section in accordance with the provisions of section #agbi of this title4 7g7 ,copayments 7#a7 ,except as provided in paragraph 7#b71 a veteran shall pay to the ,department a copayment 7in an amount prescribed by the ,secretary for purposes of this section7 for each episode of emergency treatment or urgent care for which reimbursement is provided to the veteran under this section4 7#b7 ,the requirement under paragraph 7#a7 to pay a copayment does not apply to a veteran who-- 7,a7 would not be required to pay to the ,department a copayment for emergency treatment or urgent care furnished at facilities of the ,department2 7,b7 meets an exemption specified by the ,secretary in regulations prescribed by the ,secretary for purposes of this section2 or 7,c7 is admitted to a hospital for treatment or observation following1 and in connection with1 the emergency treatment or urgent care for which the veteran is provided reimbursement under this section4 7#c7 ,the requirement that a veteran pay a copayment under this section shall apply notwithstanding the authority of the ,secretary to offset such a requirement with amounts recovered from a third party under section #agbi of this title4 7h7 ,definitions ,in this section3 7#a7 ,the term emergency treatment means medical care or services furnished1 in the judgment of the ,secretary-- 7,a7 when such care or services are rendered in a medical emergency of such nature that a prudent layperson reasonably expects that delay in seeking immediate medical attention would be hazardous to life or health2 and 7,b7 until-- 7i7 such time as the veteran can be transferred safely to a ,department facility or community care provider authorized by the ,secretary and such facility or provider is capable of accepting such transfer2 or 7ii7 such time as a ,department facility or community care provider authorized by the ,secretary accepts such transfer if-- 7,i7 at the time the veteran could have been transferred safely to such a facility or provider1 no such facility or provider agreed to accept such transfer2 and 7,,ii7 the non-,department facility in which such medical care or services was furnished made and documented reasonable attempts to transfer the veteran to a ,department facility or community care provider4 7#b7 ,the term health-plan contract includes any of the following3 7,a7 ,an insurance policy or contract1 medical or hospital service agreement1 membership or subscription contract1 or similar arrangement under which health services for individuals are provided or the expenses of such services are paid4 7,b7 ,an insurance program described in section #ahaa of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7 or established by section #ahca of such ,act 7#db ,u4,s4,c4 #acie;j74 7,c7 ,a ,state plan for medical assistance approved under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq474 7,d7 ,a workers' compensation law or plan described in section #agbi7;a77#b77;,a7 of this title4 7#c7 ,the term third party means any of the following3 7,a7 ,a ,federal entity4 7,b7 ,a ,state or political subdivision of a ,state4 7,c7 ,an employer or an employer's insurance carrier4 7,d7 ,an automobile accident reparations insurance carrier4 7,e7 ,a person or entity obligated to provide1 or to pay the expenses of1 health services under a health-plan contract4 7#d7 ,the term urgent care shall have the meaning given that term by the ,secretary in regulations prescribed by the ,secretary for purposes of this section4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag is amended by striking the item relating to section #agbe and inserting the following new item3 #agbe4 ,reimbursement for emergency treatment and urgent care4 4 7c7 ,repeal of superseded authority ,section #agbh is repealed4 7d7 ,conforming amendments 7#a7 ,medical care for survivors and dependents ,section #agha7;a77#d7 is amended by striking 7as defined in section #agbe7;f7 of this title7 and inserting 7as defined in section #agbe7;h7 of this title74 7#b7 ,health care of family members of veterans stationed at ,camp ,lejeune1 ,north ,carolina ,section #aghg7;b77#c7 is amended by striking 7as defined in section #agbe7;f7 of this title7 and inserting 7as defined in section #agbe7;h7 of this title74 7e7 ,regulations ,not later than #bgj days after the date of the enactment of this ,act1 the ,secretary shall prescribe regulations to carry out the amendments made by this section4 7f7 ,effective date ,the amendments made by this section shall take effect one year after the date of the enactment of this ,act4 #ajc4 ,termination of certain provisions authorizing care to veterans through non-,department of ,veterans ,affairs providers 7a7 ,termination of authority ,to contract for care in non-,department facilities 7#a7 ,in general ,section #agjc of title #ch1 ,united ,states ,code1 is amended by adding at the end the follow new subsection3 7e7 ,the authority of the ,secretary under this section terminates on ,december #ca1 #bjag4 4 7#b7 ,conforming amendments 7,a7 ,in general 7i7 ,dental care ,section #agab7;a7 of such title is amended-- 7,i7 in paragraph 7#c71 by striking under clause 7#a71 7#b71 or 7#e7 of section #agjc7;a7 of this title and inserting or entered into an agreement under this title2 and 7,,ii7 in paragraph 7#d77;,a71 in the first sentence-- 7aa7 by striking and section #agjc of this title2 and 7bb7 by striking in section #agjc of this title and inserting in this title4 7ii7 ,readjustment counseling ,section #agab;,a7e77#a7 of such title is amended-- 7,i7 by inserting or agreements after contracts2 and 7,,ii7 by striking 7under sections #agjc7;a77#b7 and #agaj7;a77#a77;,b7 of this title74 7iii7 ,death in ,department facility ,section #bcjc7;a77#b77;,b77i7 of such title is amended by striking section #agjc and inserting a contract or agreement entered into under this title4 7iv7 ,medicare provider agreements ,section #ahff7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77 is amended by striking under section #agjc of title #ch and inserting under title #ch1 ,united ,states ,code14 7,b7 ,effective date ,the amendments made by subparagraph 7,a7 shall take effect on ,december #ag1 #bjag4 7b7 ,repeal of authority ,to contract for scarce medical specialists 7#a7 ,in general ,section #gdji of such title is repealed4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #gd is amended by striking the item relating to section #gdji4 ,,ii ,authority to pay for non-,department care #bja4 ,authorization of agreements between the ,department of ,veterans ,affairs and non-,department health care providers 7a7 ,in general ,subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 as amended by section #aja7;a71 is further amended by inserting after section #agjc;,a the following new section3 #agjc;,b4 ,veterans ,care ,agreements 7a7 ,agreements ,to furnish care 7#a7 ,if the ,secretary is not feasibly able to furnish hospital care1 medical services1 or extended care under this chapter at facilities of the ,department or under contracts or sharing agreements entered into under authorities other than this section1 the ,secretary may furnish such care and services by entering into agreements under this section with eligible providers that are certified under subsection 7c74 ,an agreement entered into under this section may be referred to as a ,veterans ,care ,agreement4 7#b7 ,the ,secretary is not feasibly able to furnish care or services as described in paragraph 7#a7 if the ,secretary determines that the medical condition of the veteran1 the travel involved1 the nature of the care or services required1 or a combination of those factors make the use of facilities of the ,department1 contracts1 or sharing agreements impracticable or inadvisable4 7#c7 ,eligibility of a veteran under this section for the care or services described in paragraph 7#a7 shall be determined as if such care or services were furnished in a facility of the ,department and provisions of this title applicable to veterans receiving such care or services in a facility of the ,department shall apply to veterans receiving such care or services under this section4 7b7 ,eligible providers ,for purposes of this section1 an eligible provider is one of the following3 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;cc7a774 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 #acieu7h774 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 plan4 7#d7 ,a provider that is-- 7,a7 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,b7 a center for independent living 7as defined in section #gjb of the ,rehabilitation ,act of #aigc 7#bi ,u4,s4,c4 #gif;a774 7#e7 ,such other health care providers as the ,secretary considers appropriate for purposes of this section4 7c7 ,certification of eligible providers 7#a7 ,the ,secretary shall establish a process for the certification of eligible providers under this section that shall1 at a minimum1 set forth the following3 7,a7 ,procedures for the submittal of applications for certification and deadlines for actions taken by the ,secretary with respect to such applications4 7,b7 ,standards and procedures for approval and denial of certification1 duration of certification1 revocation of certification1 and recertification4 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 #acie;cc7j77#b77;,b77 and the standards set forth under section #i4ajd of title #dh1 ,code of ,federal ,regulations1 or any successor regulation4 7#b7 ,the ,secretary shall deny or revoke certification to an eligible provider under this subsection if the ,secretary determines that the eligible provider is currently-- 7,a7 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 7,b7 identified as an excluded source on the list maintained in the ,system for ,award ,management1 or any successor system4 7d7 ,terms of agreements ,each agreement entered into with an eligible provider under this section shall 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 practicable1 the rates paid by the ,united ,states for such care and services 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 seq474 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 care and services4 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 or 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 party1 as those terms are defined in section #agbi of this title1 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 or services under this section to the ,department in a timeframe and format specified by the ,secretary for purposes of this section4 7#g7 ,to meet such other terms and conditions1 including quality of care assurance standards1 as the ,secretary may specify for purposes of this section4 7e7 ,termination of agreements 7#a7 ,an eligible provider may terminate an 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 an 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 purposes of this section1 if the ,secretary-- 7,a7 determines that the eligible provider failed to comply substantially with the provisions of the agreement or with the provisions of this section and the regulations prescribed thereunder2 7,b7 determines that the 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 system2 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 or the ,department2 or 7,d7 determines that it is reasonable to terminate the agreement based on the health care needs of a veteran or veterans4 7f7 ,periodic review of certain agreements 7#a7 ,not less frequently than once every two years1 the ,secretary shall review each ,veterans ,care ,agreement of material size entered into during the two-year period preceding the review to determine whether it is feasible and advisable to furnish the hospital care1 medical services1 or extended care furnished under such agreement at facilities of the ,department or through contracts or sharing agreements entered into under authorities other than this section4 7#b7 7,a7 ,subject to subparagraph 7,b71 a ,veterans ,care ,agreement is of material size as determined by the ,secretary for purposes of this section4 7,b7 ,a ,veterans ,care ,agreement entered into after ,september #cj1 #bjaf1 for the purchase of extended care services is of material size if the purchase of such services under the agreement exceeds #a1jjj1jjj annually4 ,the ,secretary may adjust such amount to account for changes in the cost of health care based upon recognized health care market surveys and other available data and shall publish any such adjustments in the ,federal ,register4 7g7 ,exclusion of certain ,federal contracting provisions 7#a7 ,an agreement under this section may be entered into without regard to any law that would require the ,secretary to use competitive procedures in selecting the party with which to enter into the agreement4 7#b7 7,a7 ,except as provided in subparagraph 7,b7 and unless otherwise provided in this section or in regulations prescribed pursuant to this section1 an eligible provider that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7,b7 ,an eligible provider that enters into an agreement under this section is subject to-- 7i7 all laws regarding integrity1 ethics1 fraud1 or that subject a person to civil or criminal penalties2 and 7ii7 all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities4 7h7 ,monitoring of quality of care ,the ,secretary shall establish a system or systems1 consistent with survey and certification procedures used by the ,centers for ,medicare ,medicaid ,services and ,state survey agencies to the extent practicable-- 7#a7 to monitor the quality of care and services furnished to veterans under this section2 and 7#b7 to assess the quality of care and services furnished by an eligible provider for purposes of determining whether to renew an agreement under this section with the eligible provider4 7i7 ,dispute resolution 7#a7 ,the ,secretary shall establish administrative procedures for eligible providers with which the ,secretary has entered an agreement under this section 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 an agreement under this section1 an eligible provider must first exhaust the administrative procedures established by the ,secretary under paragraph 7#a74 4 7b7 ,regulations ,the ,secretary of ,veterans ,affairs shall prescribe an interim final rule to carry out section #agjc;,b of such title1 as added by subsection 7a71 not later than one year after the date of the enactment of this ,act4 7c7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title1 as amended by section #aja7;b71 is further amended by inserting after the item related to section #agjc;,a the following new item3 #agjc;,b4 ,veterans ,care ,agreements4 4 #bjb4 ,modification of authority to enter into agreements with ,state homes to provide nursing home care 7a7 ,use of agreements 7#a7 ,in general ,paragraph 7#a7 of section #agde7;a7 of title #ch1 ,united ,states ,code1 is amended1 in the matter preceding subparagraph 7,a71 by striking a contract 7or agreement under section #agbj7;c77#a7 of this title7 and inserting an agreement4 7#b7 ,payment ,paragraph 7#b7 of such section is amended by striking contract 7or agreement7 each place it appears and inserting agreement4 7b7 ,exclusion of certain ,federal contracting provisions ,such section is amended by adding at the end the following new paragraph3 7#d7 7,a7 ,an agreement under this section may be entered into without regard to any law that would require the ,secretary to use competitive procedures in selecting the party with which to enter into the agreement4 7,b7 7i7 ,except as provided in clause 7ii7 and unless otherwise provided in this section or in regulations prescribed pursuant to this section1 a ,state home that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7ii7 ,a ,state home that enters into an agreement under this section is subject to-- 7,i7 all laws regarding integrity1 ethics1 fraud1 or that subject a person to civil or criminal penalties2 and 7,,ii7 all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities4 4 7c7 ,effective date 7#a7 ,in general ,the amendments made by this section shall apply to agreements entered into under section #agde of such title on and after the date on which the regulations prescribed by the ,secretary of ,veterans ,affairs to implement such amendments take effect4 7#b7 ,publication ,the ,secretary shall publish the date described in paragraph 7#a7 in the ,federal ,register not later than #cj days before such date4 #bjc4 ,requirement for advance appropriations for the ,care in the ,community account of the ,department of ,veterans ,affairs 7a7 ,in general ,section #aag7;c7 of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new paragraph3 7#g7 ,veterans ,health ,administration1 ,care in the ,community4 4 7b7 ,conforming amendment ,section #aaje7;a77#cg7 of title #ca1 ,united ,states ,code1 is amended by adding at the end the following new subparagraph3 7,g7 ,veterans ,health ,administration1 ,care in the ,community4 4 7c7 ,applicability ,the amendments made by this section shall apply to fiscal years beginning on and after ,october #a1 #bjaf4 #bjd4 ,annual transfer of amounts within ,department of ,veterans ,affairs to pay for health care from non-,department providers ,section #ajf of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended by adding at the end the following new subsection3 7c7 ,annual transfer of amounts 7#a7 ,in general ,at the beginning of each fiscal year1 the ,secretary of ,veterans ,affairs shall transfer to the ,chief ,business ,office of the ,veterans ,health ,administration an amount equal to the amount estimated to be required to furnish hospital care1 medical services1 and other health care through non-,department of ,veterans ,affairs providers during that fiscal year4 7#b7 ,adjustments ,during a fiscal year1 the ,secretary may make adjustments to the amount transferred under paragraph 7#a7 for that fiscal year to accommodate any variances in demand for hospital care1 medical services1 or other health care through non-,department providers4 4 #bje4 ,elimination of requirement to act as secondary payer for care relating to non-service-connected disabilities under ,choice ,program 7a7 ,in general ,section #aja7;e7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended-- 7#a7 by striking paragraphs 7#b7 and 7#c72 7#b7 by redesignating paragraph 7#d7 as paragraph 7#c72 and 7#c7 by inserting after paragraph 7#a7 the following new paragraph 7#b73 7#b7 ,responsibility for costs of certain care ,in any case in which an eligible veteran is furnished hospital care or medical services under this section for a non-service-connected disability described in subsection 7a77#b7 of section #agbi of title #ch1 ,united ,states ,code1 the ,secretary may recover or collect reasonable charges for such care or services from a health-care plan described in paragraph 7#c7 in accordance with such section4 4 7b7 ,conforming amendment ,paragraph 7#a7 of such section is amended by striking paragraph 7#d7 and inserting paragraph 7#c74 #bjf4 ,authorization of use of certain amounts appropriated to the ,veterans ,choice ,fund for other non-,department of ,veterans ,affairs care 7a7 ,in general ,section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended-- 7#a7 in subsection 7c7-- 7,a7 in paragraph 7#a7-- 7i7 by striking ,except as provided by paragraph 7#c71 any and inserting ,any2 and 7ii7 by striking by the ,secretary of ,veterans ,affairs and all that follows through the period at the end and inserting 8by the ,secretary of ,veterans ,affairs-- 7,a7 to carry out section #aja1 including1 subject to paragraph 7#b71 any administrative requirements of such section2 7,b7 to furnish health care to individuals under chapter #ag of title #ch1 ,united ,states ,code1 at non-,department facilities1 including pursuant to authority other than the authority under section #aja2 and 7,c7 to furnish disability examinations conducted by health care providers that are not health care providers of the ,department of ,veterans ,affairs4 2 and 7,b7 by striking paragraph 7#c7 and inserting the following new paragraphs3 7#c7 ,treatment of amounts ,amounts made available to the ,secretary under this subsection shall be used to supplement1 not supplant1 amounts made available to the ,secretary in the ,medical ,services account of the ,department of ,veterans ,affairs4 7#d7 ,non-,department facilities defined ,in this subsection1 the term non-,department facilities has the meaning given that term in section #agja of title #ch1 ,united ,states ,code4 2 and 7#b7 in subsection 7d77#a71 by striking only for the program and all that follows through the period at the end and inserting only for the purposes specified in subsection 7c77#a744 7b7 ,emergency designations 7#a7 ,in general ,this section is designated as an emergency requirement pursuant to section #d7;g7 of the ,statutory ,pay-,as-,you-,go ,act of #bjaj 7#b ,u4,s4,c4 #icc7;g774 7#b7 ,designation in ,senate ,in the ,senate1 this section is designated as an emergency requirement pursuant to section #djc7;a7 of ,s4 ,con4 ,res4 #ac 7#aaath ,congress71 the concurrent resolution on the budget for fiscal year #bjaj4 #bjg4 ,modification of process through which ,department of ,veterans ,affairs records obligations for non-,department care 7a7 ,in general ,subchapter ,,iii of chapter #ag of title #ch1 ,united ,states ,code1 is amended by adding at the end the following new section3 #agcj;,b4 ,recording obligations for care at non-,department facilities ,the ,secretary may record as an obligation of the ,united ,states ,government amounts owed for hospital care or medical services furnished under this chapter at non-,department facilities on the date on which a claim by a health care provider for payment is approved rather than on the date that the hospital care or medical services are authorized by the ,secretary4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agcj;,a the following new item3 #agcj;,b4 ,recording obligations for care at non-,department facilities4 4 ,,iii ,other health care matters #cja4 ,treatment of ,department of ,veterans ,affairs as participating provider for recovery of costs of certain medical care ,section #agbi7;f7 of title #ch1 ,united ,states ,code1 is amended by striking 7f7 ,no law and inserting the following3 7f7 7#a7 ,in the case of a veteran who is entitled to care 7or payment of the expenses of care7 under a health-plan contract1 for purposes of reimbursement for providing care or services under this chapter to that veteran for a non-service-connected disability described in subparagraph 7,d7 or 7,e7 of subsection 7a77#b71 the ,department shall be treated as a participating provider under that health-plan contract4 7#b7 ,no law 4 #cjb4 ,primary care providers for veterans enrolled in patient enrollment system of ,department of ,veterans ,affairs 7a7 ,in general ,subchapter ,i of chapter #ag of title #ch1 ,united ,states ,code1 is amended by inserting after section #agje the following new section3 #agje;,a4 ,management of health care3 primary care provider 7a7 ,in general ,the ,secretary shall1 to the maximum extent possible1 assign each veteran enrolled in the system of annual patient enrollment established and operated under section #agje of this title a full-time primary care provider that meets the following criteria3 7#a7 ,except as provided in paragraph 7#b71 located not more than #dj miles driving distance from the residence of the veteran4 7#b7 ,if the veteran resides in a ,state without a medical facility of the ,department that provides hospital care1 emergency medical services1 and surgical care1 located not more than #bj miles driving distance from the residence of the veteran4 7#c7 ,located such that the veteran is not required to travel by air1 boat1 or ferry or overcome an unusual or excessive burden to access the primary care provider4 7b7 ,types of providers ,in carrying out this section1 the ,secretary may select from among primary care providers that are health care providers of the ,department and primary care providers that are not health care providers of the ,department4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agje the following new item3 #agje;,a4 ,management of health care3 primary care provider4 4