,,ii  #aad? ,,congress  #b;d ,session   
,s4 #bfcc  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,m>* #c1 #bjaf ,mr4    
,te/] 7= himself1 ,mr4 ,blum5?al1 ,mr4  
,b5net1 ,mr4 ,udall1 ,mr4 ,br[n1 & ,ms4 
,heitkamp7 introduc$ ! foll[+ bill2 :i* 
0 read twice & ref]r$ to ! ,committee on
 ,vet]ans' ,affairs  ,a ,,bill  ,to     
improve ! ability ( ! ,secret>y (       
,vet]ans ,affairs to provide heal? c>e  
to vet]ans ?r\gh non-,dep>tm5t heal? c>e
 provid]s1 & = o!r purposes4  #a4 ,%ort 
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,improv+      
,vet]ans ,access to ,c>e 9 ! ,community 
,act4  7b7 ,table ( cont5ts ,! table (  
cont5ts = ?is ,act is z foll[s3 ,sec4   
#a4 ,%ort title2 table ( cont5ts4       
,,title ,i--,improvem5t ( access (      
vet]ans to non-,dep>tm5t c>e ,sec4 #aja4
 ,improvem5t ( access ( vet]ans to heal?
 c>e ?r\gh e/abli%m5t ( ,vet]ans ,*oice 
,program4 ,sec4 #ajb4 ,expansion (      
reimbursem5t ( vet]ans = em]g5cy        
treatm5t & urg5t c>e4 ,sec4 #ajc4       

,t]m9ation ( c]ta9 provisions au?oriz+  
c>e to vet]ans ?r\gh non-,dep>tm5t (    
,vet]ans ,affairs provid]s4 ,,title     
,,ii--,au?ority to pay = non-,dep>tm5t  
c>e ,sec4 #bja4 ,au?orization (         
agreem5ts betwe5 ! ,dep>tm5t ( ,vet]ans 
,affairs & non-,dep>tm5t heal? c>e      
provid]s4 ,sec4 #bjb4 ,modification (   
au?ority to ent] into agreem5ts ) ,/ate 
homes to provide nurs+ home c>e4 ,sec4  
#bjc4 ,requirem5t = advance             
appropriations = ! ,c>e 9 ! ,community  
acc\nt ( ! ,dep>tm5t ( ,vet]ans         
,affairs4 ,sec4 #bjd4 ,annual transf] ( 
am\nts )9 ,dep>tm5t ( ,vet]ans ,affairs 
to pay = heal? c>e f non-,dep>tm5t      
provid]s4 ,sec4 #bje4 ,elim9ation (     
requirem5t to act z second>y pay] = c>e 
relat+ to non-s]vice-connect$           
disabilities "u ,*oice ,program4 ,sec4  
#bjf4 ,au?orization ( use ( c]ta9 am\nts
 appropriat$ to ! ,vet]ans ,*oice ,fund 
= o!r non-,dep>tm5t ( ,vet]ans ,affairs 
c>e4 ,sec4 #bjg4 ,modification ( process
 ?r\gh :i* ,dep>tm5t ( ,vet]ans ,affairs

 records obligations = non-,dep>tm5t    
c>e4 ,,title ,,iii--,o!r heal? c>e      
matt]s ,sec4 #cja4 ,treatm5t ( ,dep>tm5t
 ( ,vet]ans ,affairs z p>ticipat+       
provid] = recov]y ( co/s ( c]ta9 m$ical 
c>e4 ,sec4 #cjb4 ,prim>y c>e provid]s = 
vet]ans enroll$ 9 pati5t enrollm5t sy/em
 ( ,dep>tm5t ( ,vet]ans ,affairs4  ,i   
,improvem5t ( access ( vet]ans to       
non-,dep>tm5t c>e  #aja4 ,improvem5t (  
access ( vet]ans to heal? c>e ?r\gh     
e/abli%m5t ( ,vet]ans ,*oice ,program   
7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag ( 
title #ch1 ,unit$ ,/ates ,code1 is am5d$
 by ins]t+ aft] section #agjc ! foll[+  
new section3  #agjc;,a4 ,vet]ans ,*oice 
,program  7a7 ,9 g5]al  7#a7 ,!         
,secret>y %all ent] into contracts or   
agreem5ts "u sections #agjc;,b1 #haaa1 &
 #haec ( ?is title ) eligible provid]s  
to furni% hospital c>e & m$ical s]vices 
"u ?is *apt] to eligible vet]ans4 ,!    
provision ( hospital c>e & m$ical       
s]vices "u ?is section may be ref]r$ to 
z ! ,vet]ans ,*oice ,program4  7#b7     

,hospital c>e & m$ical s]vices %all be  
furni%$ "u ?is section to an eligible   
vet]an at ! election ( ! vet]an4  7#c7  
7,a7 ,an eligible vet]an :o makes an    
election "u p>agraph 7#b7 to receive    
hospital c>e or m$ical s]vices "u ?is   
section may select a provid] ( su* c>e  
or s]vices f among ! heal? c>e provid]s 
specifi$ 9 subsection 7c77#b7 t are     
accessible to ! vet]an4  7,b7 ,!        
,secret>y may n direct an eligible      
vet]an to a provid] t is n ! eligible   
provid] select$ by ! vet]an "u          
subp>agraph 7,a74  7b7 ,eligible vet]ans
 ,a vet]an is an eligible vet]an =      
purposes ( ?is section if-- 7#a7 !      
vet]an is enroll$ 9 ! pati5t enrollm5t  
sy/em ( ! ,dep>tm5t e/abli%$ & op]at$ "u
 section #agje ( ?is title2 &  7#b7 7,a7
 ! vet]an is unable to s*$ule an        
appo9tm5t = ! receipt ( hospital c>e or 
m$ical s]vices f a heal? c>e provid] ( !
 ,dep>tm5t )9 ! less] (--  7i7 ! wait-"t
 goals ( ! ,vet]ans ,heal? ,adm9i/ration
 = su* c>e or s]vices1 z det]m9$ by !   

,secret>y2 or  7ii7 a p]iod det]m9$ by a
 heal? c>e provid] ( ! ,dep>tm5t to be  
cl9ically necess>y = ! receipt ( su* c>e
 or s]vices2  7,b7 ! vet]an does n      
reside )9 #dj miles driv+ di/ance f a   
m$ical facility ( ! ,dep>tm5t1 includ+ a
 community-bas$ outpati5t cl9ic1 ) a    
full-"t prim>y c>e provid]2  7,c7 !     
vet]an faces an excessive burd5 9       
access+ hospital c>e or m$ical s]vices f
 a m$ical facility ( ! ,dep>tm5t due    
to--  7i7 geographical *all5ges2  7ii7  
environm5tal factors2  7iii7 a m$ical   
condition ( ! vet]an t affects ! ability
 to travel2 or  7iv7 su* o!r factors z  
det]m9$ by ! ,secret>y2  7,d7 ! hospital
 c>e or m$ical s]vices s\ght by ! vet]an
 are n provid$ at a m$ical facility ( ! 
,dep>tm5t t is accessible to ! vet]an2  
7,e7 ! vet]an is enroll$ 9 ! pilot      
program "u section #djc ( ! ,vet]ans'   
,m5tal ,heal? & ,o!r ,c>e ,improvem5ts  
,act ( #bjjh 7,public ,law #aaj-chg2 #ch
 ,u4,s4,c4 #agjc note7 z ( ! date ( !   
enactm5t ( ! ,improv+ ,vet]ans ,access  

to ,c>e 9 ! ,community ,act2  7,f7 !    
vet]an is assign$ a prim>y c>e provid]  
"u section #agje;,a ( ?is title t is n a
 heal? c>e provid] ( ! ,dep>tm5t2 &     
7,g7 !re is a compell+ reason1 z det]m9$
 by ! ,secret>y1 t ! vet]an ne$s to     
receive hospital c>e or m$ical s]vices f
 a m$ical facility o!r ?an a m$ical     
facility ( ! ,dep>tm5t4  7c7 ,eligible  
provid]s  7#a7 ,a heal? c>e provid] is  
an eligible provid] = purposes ( ?is    
section if ! heal? c>e provid] is a     
heal? c>e provid] specifi$ 9 p>agraph   
7#b7 & meets /&>ds e/abli%$ by !        
,secret>y = purposes ( ?is section1     
includ+ /&>ds relat+ to education1      
c]tification1 lic5sure1 tra9+1 &        
employm5t hi/ory4  7#b7 ,! heal? c>e    
provid]s specifi$ 9 ?is p>agraph are !  
foll[+3 7,a7 ,any heal? c>e provid] t is
 p>ticipat+ 9 ! ,m$ic>e program "u title
 ,,xviii ( ! ,social ,security ,act 7#db
 ,u4,s4,c4 #acie et seq471 includ+ any  
physician furni%+ s]vices "u su*        
program4  7,b7 ,any heal? c>e provid] ( 

a ,f$]ally-qualifi$ heal? c5t] 7z def9$ 
9 section #aije7l77#b77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acif;d7l77#b77;,b7774  7,c7 ,any heal? 
c>e provid] ( ! ,dep>tm5t ( ,def5se4    
7,d7 ,any heal? c>e provid] ( ! ,indian 
,heal? ,s]vice4  7,e7 ,any heal? c>e    
provid] ( an academic affiliate ( !     
,dep>tm5t ( ,vet]ans ,affairs4  7,f7    
,any heal? c>e provid] ( a heal? sy/em  
e/abli%$ to s]ve ,alaska ,natives4  7,g7
 ,any o!r heal? c>e provid] t meets     
crit]ia e/abli%$ by ! ,secret>y =       
purposes ( ?is section4  7#c7 ,to       
promote ! provision ( high-quality &    
high-value heal? c>e "u ?is section1 !  
,secret>y may develop a ti]$ provid]    
network ( eligible provid]s bas$ on     
crit]ia e/abli%$ by ! ,secret>y =       
purposes ( ?is section4  7d7            
,reimbursem5t rates  7#a7 ,! ,secret>y  
%all be prim>ily responsible = ! paym5t 
( co/s associat$ ) hospital c>e & m$ical
 s]vices furni%$ "u ?is section4  7#b7  
,to ! ext5t practicable1 ! rates paid by

 ! ,secret>y = hospital c>e & m$ical    
s]vices furni%$ "u ?is section--  7,a7  
%all n be m ?an ! rates paid by ! ,unit$
 ,/ates to a provid] ( s]vices 7z def9$ 
9 section #ahfa7u7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciex7u777 or a   
suppli] 7z def9$ 9 section #ahfa7;d7 (  
su* ,act 7#db ,u4,s4,c4 #aciex7d777 "u !
 ,m$ic>e program "u title ,,xviii ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 = ! same c>e or s]vices2 
&  7,b7 %all incorporate ! use (        
value-bas$ reimbursem5t models to       
promote ! provision ( high-quality c>e4 
7e7 ,prompt paym5t /&>d  7#a7 ,an       
eligible provid] t seeks reimbursem5t = 
hospital c>e or m$ical s]vices furni%$  
"u ?is section %all submit to !         
,secret>y a claim = reimbursem5t n lat] 
?an #ahj days aft] furni%+ su* c>e or   
s]vices4  7#b7 ,not)/&+ any o!r         
provision ( law1 ! ,secret>y %all       
reimburse an eligible provid] = hospital
 c>e or m$ical s]vices furni%$ "u ?is   
section--  7,a7 9 ! case ( a clean claim

 submitt$ to ! ,secret>y on pap]1 n lat]
 ?an #de cal5d> days aft] receiv+ !     
claim2 or  7,b7 9 ! case ( a clean claim
 submitt$ to ! ,secret>y electronically1
 n lat] ?an #cj cal5d> days aft] receiv+
 ! claim4  7#c7 7,a7 ,if ! ,secret>y    
d5ies a claim submitt$ by an eligible   
provid] "u p>agraph 7#a71 ! ,secret>y   
%all notify ! eligible provid] ( !      
reason = d5y+ ! claim & ! additional    
in=mation1 if any1 t may be requir$ to  
process ! claim--  7i7 9 ! case ( a     
clean claim submitt$ to ! ,secret>y on  
pap]1 n lat] ?an #de cal5d> days aft]   
receiv+ ! claim2 or  7ii7 9 ! case ( a  
clean claim submitt$ to ! ,secret>y     
electronically1 n lat] ?an #cj cal5d>   
days aft] receiv+ ! claim4  7,b7 ,^u    
receipt by ! ,secret>y ( additional     
in=mation specifi$ "u subp>agraph 7,a7  
relat+ to a claim1 ! ,secret>y %all pay1
 d5y1 or o!rwise adjudicate ! claim1 z  
appropriate1 n lat] ?an #cj cal5d> days 
aft] receiv+ su* in=mation4  7#d7 7,a7  
,if ! ,secret>y has n reimburs$ an      

eligible provid] or d5i$ a claim =      
reimbursem5t by ! eligible provid] "u   
?is subsection dur+ ! appropriate p]iod 
specifi$ 9 ?is subsection1 su* claim    
%all be consid]$ ov]due4  7,b7 ,if a    
valid claim = reimbursem5t by an        
eligible provid] is consid]$ ov]due "u  
subp>agraph 7,a71 9 addition to ! am\nt 
! ,secret>y owes ! eligible provid] "u !
 claim1 ! ,secret>y %all owe ! eligible 
provid] an int]e/ p5alty am\nt t %all-- 
7i7 be prorat$ daily2  7ii7 accrue f !  
date ! paym5t 0 ov]due2  7iii7 be       
payable at ! "t ! claim is paid2 &  7iv7
 be comput$ at ! rate ( int]e/ e/abli%$ 
by ! ,secret>y ( ! ,treasury1 & publi%$ 
9 ! ,f$]al ,regi/]1 = int]e/ paym5ts "u 
subsections 7a77#a7 & 7b7 ( section     
#gaji ( title #da t is 9 effect at ! "t 
! ,secret>y accrues ! obligation to pay 
! int]e/ p5alty am\nt4  7#e7 7,a7 ,if ! 
,secret>y ov]pays an eligible provid] = 
hospital c>e or m$ical s]vices furni%$  
"u ?is section1 ! ,secret>y %all d$uct !
 am\nt ( any ov]paym5t f paym5ts due to 

! eligible provid] aft] ! date ( su*    
ov]paym5t4  7,b7 7i7 ,be=e d$uct+ any   
am\nt f a paym5t to an eligible provid] 
"u subp>agraph 7,a71 ! ,secret>y %all   
ensure t ! eligible provid] is provid$  
an opportunity--  7,i7 to dispute !     
exi/5ce or am\nt ( any ov]paym5t ow$ to 
! ,dep>tm5t2 &  7,,ii7 to reque/ a      
compromise ) respect to any su*         
ov]paym5t4  7ii7 ,! ,secret>y may n make
 any d$uction f a paym5t to an eligible 
provid] "u subp>agraph 7,a7 unless !    
,secret>y has made reasonable ef=ts to  
notify ! eligible provid] ( ! rights ( !
 eligible provid] "u subclauses 7,i7 &  
7,,ii7 ( clause 7i74  7iii7 ,^u receiv+ 
a dispute "u subclause 7,i7 ( clause 7i7
 or a reque/ "u subclause 7,,ii7 ( su*  
clause1 ! ,secret>y %all make a         
det]m9ation ) respect to su* dispute or 
reque/ be=e mak+ any d$uction "u        
subp>agraph 7,a7 unless ! "t requir$ to 
make su* a det]m9ation w\ld jeop>dize ! 
ability ( ! ,secret>y to recov] ! full  
am\nt ow$ to ! ,dep>tm5t4  7#f7 ,not)/&+

 any o!r provision ( law-- 7,a7 !       
au?ority ( ! ,secret>y to make d$uctions
 "u p>agraph 7#e7 or take any o!r action
 = ! purpose ( collect+ a debt ow$ to ! 
,unit$ ,/ates "u ?is section %all n be  
subject to any limitation ) respect to !
 "t = br++ civil actions or = comm5c+   
adm9i/rative proce$+s2 &  7,b7 !        
,secret>y may1 except 9 ! case ( a      
fraudul5t claim1 false claim1 or        
misrepres5t$ claim1 compromise any claim
 ( an am\nt ow$ to ! ,unit$ ,/ates "u   
?is section4  7#g7 ,?is subsection %all 
apply only to paym5ts made on a claims  
basis & n to capitation or o!r =ms (    
p]iodic paym5ts to eligible provid]s4   
7f7 ,co/ %>+  7#a7 ,! ,secret>y %all    
require an eligible vet]an to pay a     
copaym5t = ! receipt ( hospital c>e or  
m$ical s]vices "u ?is section only if   
su* eligible vet]an w\ld be requir$ to  
pay a copaym5t = ! receipt ( su* c>e or 
s]vices "u ?is *apt] at a m$ical        
facility ( ! ,dep>tm5t or f a heal? c>e 
provid] ( ! ,dep>tm5t4  7#b7 ,! am\nt ( 

any copaym5t *>g$ to an eligible vet]an 
"u p>agraph 7#a7 = ! receipt ( hospital 
c>e or m$ical s]vices "u ?is section may
 n exce$ ! am\nt ( ! copaym5t t w\ld be 
payable by su* eligible vet]an = !      
receipt ( su* c>e or s]vices "u ?is     
*apt] at a m$ical facility ( ! ,dep>tm5t
 or f a heal? c>e provid] ( ! ,dep>tm5t4
  7g7 ,coord9ation ( c>e & s]vices ,!   
,secret>y %all e/abli% su* proc$ures to 
promote coord9ation ( c>e & ! %>+ (     
heal? in=mation z ! ,secret>y consid]s  
appropriate to c>ry out ?is section4    
7h7 ,regulations ,! ,secret>y %all      
prescribe regulations to c>ry out ?is   
section4  7i7 ,effective date ,!        
,secret>y may n furni% hospital c>e or  
m$ical s]vices "u ?is section be=e !    
date specifi$ 9 section #aja7p77#b7 ( ! 
,vet]ans ,access1 ,*oice1 &             
,acc\ntability ,act ( #bjad 7,public    
,law #aac-adf2 #ch ,u4,s4,c4 #agja      
note74  7j7 ,def9itions ,9 ?is section3 
7#a7 ,! t]m ,alaska ,native means a     
p]son :o is a memb] ( any ,native       

village1 ,village ,corporation1 or      
,regional ,corporation1 z ^? t]ms are   
def9$ 9 section #c ( ! ,alaska ,native  
,claims ,settlem5t ,act 7#dc ,u4,s4,c4  
#afjb74  7#b7 ,! t]m clean claim means a
 claim submitt$-- 7,a7 to ! ,secret>y by
 an eligible provid] = purposes ( paym5t
 by ! ,secret>y ( exp5ses = hospital c>e
 or m$ical s]vices furni%$ "u ?is       
section2  7,b7 t conta9s sub/antially   
all ( ! requir$ elem5ts necess>y =      
accurate adjudication1 )\t requir+      
additional in=mation f ! eligible       
provid]2 &  7,c7 9 su* =mat z may be    
prescrib$ by ! ,secret>y = purposes (   
pay+ claims = hospital c>e or m$ical    
s]vices furni%$ "u ?is section4  7#c7 ,!
 t]m fraudul5t claim-- 7,a7 means a     
claim by a heal? c>e provid] =          
reimbursem5t "u ?is section t includes  
an int5tional & delib]ate               
misrepres5tation ( a mat]ial fact or    
facts t is int5d$ to induce ! ,secret>y 
to pay an am\nt t 0 n legally ow$ to !  
provid]2 &  7,b7 does n include a claim 

9 :i* a misrepres5tation is made 9      
reliance on a good fai? int]pretation by
 a heal? c>e provid] ( ! utilization1   
m$ical necessity1 cod+1 or bill+        
requirem5ts ( ! ,secret>y4  4  7b7      
,cl]ical am5dm5t ,! table ( sections at 
! beg9n+ ( *apt] #ag ( su* title is     
am5d$ by ins]t+ aft] ! item relat+ to   
section #agjc ! foll[+ new item3        
#agjc;,a4 ,vet]ans ,*oice ,program4  4  
#ajb4 ,expansion ( reimbursem5t (       
vet]ans = em]g5cy treatm5t & urg5t c>e  
7a7 ,9 g5]al ,section #agbe ( title #ch1
 ,unit$ ,/ates ,code1 is am5d$ to read z
 foll[s3  #agbe4 ,reimbursem5t = em]g5cy
 treatm5t & urg5t c>e  7a7 ,9 g5]al     
7#a7 ,subject to ! provisions ( ?is     
section1 ! ,secret>y %all reimburse a   
vet]an describ$ 9 subsection 7b7 = !    
reasonable value ( em]g5cy treatm5t or  
urg5t c>e furni%$ ! vet]an 9 a          
non-,dep>tm5t facility4  7#b7 ,9 any    
case 9 :i* reimbursem5t ( a vet]an is   
au?oriz$ "u p>agraph 7#a71 ! ,secret>y  
may1 9 lieu ( reimburs+ ! vet]an1 make  

paym5t ( ! reasonable value ( ! furni%$ 
em]g5cy treatm5t or urg5t c>e directly--
  7,a7 to ! hospital or o!r heal? c>e   
provid] t furni%$ ! treatm5t or c>e2 or 
7,b7 to ! p]son or organization t paid =
 su* treatm5t or c>e on behalf ( !      
vet]an4  7b7 ,eligibility ,a vet]an     
describ$ 9 ?is subsection is an         
individual :o-- 7#a7 is enroll$ 9 !     
pati5t enrollm5t sy/em ( ! ,dep>tm5t    
e/abli%$ & op]at$ "u section #agje ( ?is
 title2 &  7#b7 has receiv$ c>e "u ?is  
*apt] dur+ ! #bd-mon? p]iod prec$+ !    
furni%+ ( ! em]g5cy treatm5t or urg5t   
c>e = :i* reimbursem5t is s\ght "u ?is  
section4  7c7 ,em]g5cy transportation   
,not)/&+ section #aaa ( ?is title1      
reimbursem5t ( em]g5cy treatm5t or urg5t
 c>e "u ?is section %all include        
reimbursem5t = ! reasonable value (     
em]g5cy transportation4  7d7            
,responsibility = paym5t ,! ,secret>y   
%all be prim>ily responsible = reimburs+
 or o!rwise pay+ ! reasonable value (   
em]g5cy treatm5t or urg5t c>e "u ?is    

section4  7e7 ,limitations on paym5t    
7#a7 ,! ,secret>y1 9 accordance )       
regulations prescrib$ by ! ,secret>y =  
purposes ( ?is section1 %all--  7,a7    
e/abli% ! maximum am\nt payable "u      
subsection 7a72 &  7,b7 del9eate !      
circum/ances "u :i* su* paym5ts may be  
made1 includ+ su* requirem5ts on reque/+
 reimbursem5t z ! ,secret>y may e/abli%4
  7#b7 7,a7 ,paym5t by ! ,secret>y "u   
?is section on behalf ( a vet]an to a   
provid] ( em]g5cy treatm5t or urg5t c>e 
%all1 unless reject$ & refund$ by !     
provid] )9 #cj days ( receipt--  7i7    
con/itute paym5t 9 full = ! em]g5cy     
treatm5t or urg5t c>e provid$2 &  7ii7  
ext+ui% any liability on ! "p ( ! vet]an
 = t treatm5t or c>e4  7,b7 ,nei!r !    
abs5ce ( a contract or agreem5t betwe5 !
 ,secret>y & a provid] ( em]g5cy        
treatm5t or urg5t c>e nor any provision 
( a contract1 agreem5t1 or assignm5t to 
! contr>y %all op]ate to modify1 limit1 
or negate ! requirem5ts ( subp>agraph   
7,a74  7,c7 ,a provid] ( em]g5cy        

treatm5t or urg5t c>e may n seek to     
recov] f any ?ird p>ty ! co/ ( em]g5cy  
treatm5t or urg5t c>e = :i* ! provid]   
has receiv$ paym5t f ! ,secret>y "u ?is 
section4  7f7 ,recov]y ,! ,unit$ ,/ates 
has ! "r to recov] or collect reasonable
 *>ges = em]g5cy treatm5t or urg5t c>e  
furni%$ "u ?is section 9 accordance ) ! 
provisions ( section #agbi ( ?is title4 
7g7 ,copaym5ts  7#a7 ,except z provid$ 9
 p>agraph 7#b71 a vet]an %all pay to !  
,dep>tm5t a copaym5t 79 an am\nt        
prescrib$ by ! ,secret>y = purposes (   
?is section7 = ea* episode ( em]g5cy    
treatm5t or urg5t c>e = :i* reimbursem5t
 is provid$ to ! vet]an "u ?is section4 
7#b7 ,! requirem5t "u p>agraph 7#a7 to  
pay a copaym5t does n apply to a vet]an 
:o-- 7,a7 w\ld n be requir$ to pay to ! 
,dep>tm5t a copaym5t = em]g5cy treatm5t 
or urg5t c>e furni%$ at facilities ( !  
,dep>tm5t2  7,b7 meets an exemption     
specifi$ by ! ,secret>y 9 regulations   
prescrib$ by ! ,secret>y = purposes (   
?is section2 or  7,c7 is admitt$ to a   

hospital = treatm5t or obs]vation       
foll[+1 & 9 connection )1 ! em]g5cy     
treatm5t or urg5t c>e = :i* ! vet]an is 
provid$ reimbursem5t "u ?is section4    
7#c7 ,! requirem5t t a vet]an pay a     
copaym5t "u ?is section %all apply      
not)/&+ ! au?ority ( ! ,secret>y to     
(fset su* a requirem5t ) am\nts recov]$ 
f a ?ird p>ty "u section #agbi ( ?is    
title4  7h7 ,def9itions ,9 ?is section3 
7#a7 ,! t]m em]g5cy treatm5t means      
m$ical c>e or s]vices furni%$1 9 !      
judgm5t ( ! ,secret>y--  7,a7 :5 su* c>e
 or s]vices are r5d]$ 9 a m$ical em]g5cy
 ( su* nature t a prud5t layp]son       
reasonably expects t delay 9 seek+      
imm$iate m$ical att5tion w\ld be haz>d\s
 to life or heal?2 &  7,b7 until-- 7i7  
su* "t z ! vet]an c be transf]r$ safely 
to a ,dep>tm5t facility or community c>e
 provid] au?oriz$ by ! ,secret>y & su*  
facility or provid] is capable ( accept+
 su* transf]2 or  7ii7 su* "t z a       
,dep>tm5t facility or community c>e     
provid] au?oriz$ by ! ,secret>y accepts 

su* transf] if--  7,i7 at ! "t ! vet]an 
c\ld h be5 transf]r$ safely to su* a    
facility or provid]1 no su* facility or 
provid] agre$ to accept su* transf]2 &  
7,,ii7 ! non-,dep>tm5t facility 9 :i*   
su* m$ical c>e or s]vices 0 furni%$ made
 & docum5t$ reasonable attempts to      
transf] ! vet]an to a ,dep>tm5t facility
 or community c>e provid]4  7#b7 ,! t]m 
heal?-plan contract includes any ( !    
foll[+3 7,a7 ,an insurance policy or    
contract1 m$ical or hospital s]vice     
agreem5t1 memb]%ip or subscription      
contract1 or simil> arrangem5t "u :i*   
heal? s]vices = individuals are provid$ 
or ! exp5ses ( su* s]vices are paid4    
7,b7 ,an insurance program describ$ 9   
section #ahaa ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acie;c7 or e/abli%$ by 
section #ahca ( su* ,act 7#db ,u4,s4,c4 
#acie;j74  7,c7 ,a ,/ate plan = m$ical  
assi/ance approv$ "u title ,,xix ( su*  
,act 7#db ,u4,s4,c4 #acif et seq474     
7,d7 ,a work]s' comp5sation law or plan 
describ$ 9 section #agbi7;a77#b77;,a7 ( 

?is title4  7#c7 ,! t]m ?ird p>ty means 
any ( ! foll[+3 7,a7 ,a ,f$]al entity4  
7,b7 ,a ,/ate or political subdivision (
 a ,/ate4  7,c7 ,an employ] or an       
employ]'s insurance c>ri]4  7,d7 ,an    
automobile accid5t rep>ations insurance 
c>ri]4  7,e7 ,a p]son or entity obligat$
 to provide1 or to pay ! exp5ses (1     
heal? s]vices "u a heal?-plan contract4 
7#d7 ,! t]m urg5t c>e %all h ! mean+    
giv5 t t]m by ! ,secret>y 9 regulations 
prescrib$ by ! ,secret>y = purposes (   
?is section4  4  7b7 ,cl]ical am5dm5t ,!
 table ( sections at ! beg9n+ ( *apt]   
#ag is am5d$ by /rik+ ! item relat+ to  
section #agbe & ins]t+ ! foll[+ new     
item3  #agbe4 ,reimbursem5t = em]g5cy   
treatm5t & urg5t c>e4  4  7c7 ,repeal ( 
sup]s$$ au?ority ,section #agbh is      
repeal$4  7d7 ,con=m+ am5dm5ts  7#a7    
,m$ical c>e = survivors & dep5d5ts      
,section #agha7;a77#d7 is am5d$ by /rik+
 7z def9$ 9 section #agbe7;f7 ( ?is     
title7 & ins]t+ 7z def9$ 9 section      
#agbe7;h7 ( ?is title74  7#b7 ,heal? c>e

 ( family memb]s ( vet]ans /ation$ at   
,camp ,lejeune1 ,nor? ,c>ol9a ,section  
#aghg7;b77#c7 is am5d$ by /rik+ 7z def9$
 9 section #agbe7;f7 ( ?is title7 &     
ins]t+ 7z def9$ 9 section #agbe7;h7 (   
?is title74  7e7 ,regulations ,n lat]   
?an #bgj days aft] ! date ( ! enactm5t (
 ?is ,act1 ! ,secret>y %all prescribe   
regulations to c>ry out ! am5dm5ts made 
by ?is section4  7f7 ,effective date ,! 
am5dm5ts made by ?is section %all take  
effect "o ye> aft] ! date ( ! enactm5t (
 ?is ,act4  #ajc4 ,t]m9ation ( c]ta9    
provisions au?oriz+ c>e to vet]ans ?r\gh
 non-,dep>tm5t ( ,vet]ans ,affairs      
provid]s  7a7 ,t]m9ation ( au?ority ,to 
contract = c>e 9 non-,dep>tm5t          
facilities  7#a7 ,9 g5]al ,section #agjc
 ( title #ch1 ,unit$ ,/ates ,code1 is   
am5d$ by add+ at ! end ! foll[ new      
subsection3  7e7 ,! au?ority ( !        
,secret>y "u ?is section t]m9ates on    
,decemb] #ca1 #bjag4  4  7#b7 ,con=m+   
am5dm5ts  7,a7 ,9 g5]al  7i7 ,d5tal c>e 
,section #agab7;a7 ( su* title is       

am5d$--  7,i7 9 p>agraph 7#c71 by /rik+ 
"u clause 7#a71 7#b71 or 7#e7 ( section 
#agjc7;a7 ( ?is title & ins]t+ or ent]$ 
into an agreem5t "u ?is title2 &  7,,ii7
 9 p>agraph 7#d77;,a71 9 ! fir/ s5t5ce--
  7aa7 by /rik+ & section #agjc ( ?is   
title2 &  7bb7 by /rik+ 9 section #agjc 
( ?is title & ins]t+ 9 ?is title4  7ii7 
,readju/m5t c\nsel+ ,section            
#agab;,a7e77#a7 ( su* title is am5d$--  
7,i7 by ins]t+ or agreem5ts aft]        
contracts2 &  7,,ii7 by /rik+ 7"u       
sections #agjc7;a77#b7 &                
#agaj7;a77#a77;,b7 ( ?is title74  7iii7 
,dea? 9 ,dep>tm5t facility ,section     
#bcjc7;a77#b77;,b77i7 ( su* title is    
am5d$ by /rik+ section #agjc & ins]t+ a 
contract or agreem5t ent]$ into "u ?is  
title4  7iv7 ,m$ic>e provid] agreem5ts  
,section #ahff7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #acie;cc7a77 is    
am5d$ by /rik+ "u section #agjc ( title 
#ch & ins]t+ "u title #ch1 ,unit$ ,/ates
 ,code14  7,b7 ,effective date ,!       
am5dm5ts made by subp>agraph 7,a7 %all  

take effect on ,decemb] #ag1 #bjag4  7b7
 ,repeal ( au?ority ,to contract = sc>ce
 m$ical speciali/s  7#a7 ,9 g5]al       
,section #gdji ( su* title is repeal$4  
7#b7 ,cl]ical am5dm5t ,! table (        
sections at ! beg9n+ ( *apt] #gd is     
am5d$ by /rik+ ! item relat+ to section 
#gdji4  ,,ii ,au?ority to pay =         
non-,dep>tm5t c>e  #bja4 ,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 z am5d$ by section #aja7;a71 is  
fur!r am5d$ by ins]t+ aft] section      
#agjc;,a ! foll[+ new section3          
#agjc;,b4 ,vet]ans ,c>e ,agreem5ts  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[+3  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$]al     
,regi/]4  7g7 ,exclusion ( c]ta9 ,f$]al 
contract+ provisions  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 9 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 to 
:i* provid]s ( s]vices & suppli]s "u !  
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 are n subject4  7,b7 ,an 
eligible provid] t ent]s into an        
agreem5t "u ?is section is subject to-- 
7i7 all laws reg>d+ integrity1 e?ics1   
fraud1 or t subject a p]son to civil or 
crim9al p5alties2 &  7ii7 all laws t    

protect aga9/ employm5t discrim9ation or
 t o!rwise ensure equal employm5t       
opportunities4  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;,b ( 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* title1 z am5d$ by section #aja7;b71 
is fur!r am5d$ by ins]t+ aft] ! item    
relat$ to section #agjc;,a ! foll[+ new 
item3  #agjc;,b4 ,vet]ans ,c>e          
,agreem5ts4  4  #bjb4 ,modification (   
au?ority to ent] into agreem5ts ) ,/ate 
homes 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 9 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 to :i*        
provid]s ( s]vices & suppli]s "u !      
,m$ic>e program "u title ,,xviii ( !    
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 are n subject4  7ii7 ,a  
,/ate home t ent]s into an agreem5t "u  
?is section is subject to-- 7,i7 all    
laws reg>d+ integrity1 e?ics1 fraud1 or 
t subject a p]son to civil or crim9al   
p5alties2 &  7,,ii7 all laws t protect  
aga9/ employm5t discrim9ation or t      

o!rwise ensure equal employm5t          
opportunities4  4  7c7 ,effective date  
7#a7 ,9 g5]al ,! am5dm5ts made by ?is   
section %all apply to agreem5ts ent]$   
into "u section #agde ( su* title on &  
aft] ! date on :i* ! regulations        
prescrib$ by ! ,secret>y ( ,vet]ans     
,affairs to implem5t su* am5dm5ts take  
effect4  7#b7 ,publication ,! ,secret>y 
%all publi% ! date describ$ 9 p>agraph  
7#a7 9 ! ,f$]al ,regi/] n lat] ?an #cj  
days be=e su* date4  #bjc4 ,requirem5t =
 advance appropriations = ! ,c>e 9 !    
,community acc\nt ( ! ,dep>tm5t (       
,vet]ans ,affairs  7a7 ,9 g5]al ,section
 #aag7;c7 ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$ by add+ at ! end !      
foll[+ new p>agraph3  7#g7 ,vet]ans     
,heal? ,adm9i/ration1 ,c>e 9 !          
,community4  4  7b7 ,con=m+ am5dm5t     
,section #aaje7;a77#cg7 ( title #ca1    
,unit$ ,/ates ,code1 is am5d$ by add+ at
 ! end ! foll[+ new subp>agraph3  7,g7  
,vet]ans ,heal? ,adm9i/ration1 ,c>e 9 ! 
,community4  4  7c7 ,applicability ,!   

am5dm5ts made by ?is section %all apply 
to fiscal ye>s beg9n+ on & aft] ,octob] 
#a1 #bjaf4  #bjd4 ,annual transf] (     
am\nts )9 ,dep>tm5t ( ,vet]ans ,affairs 
to pay = heal? c>e f non-,dep>tm5t      
provid]s  ,section #ajf ( ! ,vet]ans    
,access1 ,*oice1 & ,acc\ntability ,act (
 #bjad 7,public ,law #aac-adf2 #ch      
,u4,s4,c4 #agja note7 is am5d$ by add+  
at ! end ! foll[+ new subsection3  7c7  
,annual transf] ( am\nts  7#a7 ,9 g5]al 
,at ! beg9n+ ( ea* fiscal ye>1 !        
,secret>y ( ,vet]ans ,affairs %all      
transf] to ! ,*ief ,bus9ess ,(fice ( !  
,vet]ans ,heal? ,adm9i/ration an am\nt  
equal to ! am\nt e/imat$ to be requir$  
to furni% hospital c>e1 m$ical s]vices1 
& o!r heal? c>e ?r\gh non-,dep>tm5t (   
,vet]ans ,affairs provid]s dur+ t fiscal
 ye>4  7#b7 ,adju/m5ts ,dur+ a fiscal   
ye>1 ! ,secret>y may make adju/m5ts to !
 am\nt transf]r$ "u p>agraph 7#a7 = t   
fiscal ye> to accommodate any v>iances 9
 dem& = hospital c>e1 m$ical s]vices1 or
 o!r heal? c>e ?r\gh non-,dep>tm5t      

provid]s4  4  #bje4 ,elim9ation (       
requirem5t to act z second>y pay] = c>e 
relat+ to non-s]vice-connect$           
disabilities "u ,*oice ,program  7a7 ,9 
g5]al ,section #aja7;e7 ( ! ,vet]ans    
,access1 ,*oice1 & ,acc\ntability ,act (
 #bjad 7,public ,law #aac-adf2 #ch      
,u4,s4,c4 #agja note7 is am5d$--  7#a7  
by /rik+ p>agraphs 7#b7 & 7#c72  7#b7 by
 r$esignat+ p>agraph 7#d7 z p>agraph    
7#c72 &  7#c7 by ins]t+ aft] p>agraph   
7#a7 ! foll[+ new p>agraph 7#b73  7#b7  
,responsibility = co/s ( c]ta9 c>e ,9   
any case 9 :i* an eligible vet]an is    
furni%$ hospital c>e or m$ical s]vices  
"u ?is section = a non-s]vice-connect$  
disability describ$ 9 subsection 7a77#b7
 ( section #agbi ( title #ch1 ,unit$    
,/ates ,code1 ! ,secret>y may recov] or 
collect reasonable *>ges = su* c>e or   
s]vices f a heal?-c>e plan describ$ 9   
p>agraph 7#c7 9 accordance ) su*        
section4  4  7b7 ,con=m+ am5dm5t        
,p>agraph 7#a7 ( su* section is am5d$ by
 /rik+ p>agraph 7#d7 & ins]t+ p>agraph  

7#c74  #bjf4 ,au?orization ( use ( c]ta9
 am\nts appropriat$ to ! ,vet]ans ,*oice
 ,fund = o!r non-,dep>tm5t ( ,vet]ans   
,affairs c>e  7a7 ,9 g5]al ,section #hjb
 ( ! ,vet]ans ,access1 ,*oice1 &        
,acc\ntability ,act ( #bjad 7,public    
,law #aac-adf2 #ch ,u4,s4,c4 #agja note7
 is am5d$--  7#a7 9 subsection 7c7--    
7,a7 9 p>agraph 7#a7--  7i7 by /rik+    
,except z provid$ by p>agraph 7#c71 any 
& ins]t+ ,any2 &  7ii7 by /rik+ by !    
,secret>y ( ,vet]ans ,affairs & all t   
foll[s ?r\gh ! p]iod at ! end & ins]t+  
8by ! ,secret>y ( ,vet]ans ,affairs--   
7,a7 to c>ry out section #aja1 includ+1 
subject to p>agraph 7#b71 any           
adm9i/rative requirem5ts ( su* section2 
7,b7 to furni% heal? c>e to individuals 
"u *apt] #ag ( title #ch1 ,unit$ ,/ates 
,code1 at non-,dep>tm5t facilities1     
includ+ pursuant to au?ority o!r ?an !  
au?ority "u section #aja2 &  7,c7 to    
furni% disability exam9ations conduct$  
by heal? c>e provid]s t are n heal? c>e 
provid]s ( ! ,dep>tm5t ( ,vet]ans       

,affairs4  2 &  7,b7 by /rik+ p>agraph  
7#c7 & ins]t+ ! foll[+ new p>agraphs3   
7#c7 ,treatm5t ( am\nts ,am\nts made    
available to ! ,secret>y "u ?is         
subsection %all be us$ to supplem5t1 n  
supplant1 am\nts made available to !    
,secret>y 9 ! ,m$ical ,s]vices acc\nt ( 
! ,dep>tm5t ( ,vet]ans ,affairs4  7#d7  
,non-,dep>tm5t facilities def9$ ,9 ?is  
subsection1 ! t]m non-,dep>tm5t         
facilities has ! mean+ giv5 t t]m 9     
section #agja ( title #ch1 ,unit$ ,/ates
 ,code4  2 &  7#b7 9 subsection 7d77#a71
 by /rik+ only = ! program & all t      
foll[s ?r\gh ! p]iod at ! end & ins]t+  
only = ! purposes specifi$ 9 subsection 
7c77#a744  7b7 ,em]g5cy designations    
7#a7 ,9 g5]al ,?is section is designat$ 
z an em]g5cy requirem5t pursuant to     
section #d7;g7 ( ! ,/atutory            
,pay-,z-,y-,g ,act ( #bjaj 7#b ,u4,s4,c4
 #icc7;g774  7#b7 ,designation 9 ,s5ate 
,9 ! ,s5ate1 ?is section is designat$ z 
an em]g5cy requirem5t pursuant to       
section #djc7;a7 ( ,s4 ,con4 ,res4 #ac  

7#aaa? ,congress71 ! concurr5t          
resolution on ! budget = fiscal ye>     
#bjaj4  #bjg4 ,modification ( process   
?r\gh :i* ,dep>tm5t ( ,vet]ans ,affairs 
records obligations = non-,dep>tm5t c>e 
7a7 ,9 g5]al ,sub*apt] ,,iii ( *apt] #ag
 ( title #ch1 ,unit$ ,/ates ,code1 is   
am5d$ by add+ at ! end ! foll[+ new     
section3  #agcj;,b4 ,record+ obligations
 = c>e at non-,dep>tm5t facilities ,!   
,secret>y may record z an obligation ( !
 ,unit$ ,/ates ,gov]nm5t am\nts ow$ =   
hospital c>e or m$ical s]vices furni%$  
"u ?is *apt] at non-,dep>tm5t facilities
 on ! date on :i* a claim by a heal? c>e
 provid] = paym5t is approv$ r ?an on ! 
date t ! hospital c>e or m$ical s]vices 
are au?oriz$ by ! ,secret>y4  4  7b7    
,cl]ical am5dm5t ,! table ( sections at 
! beg9n+ ( *apt] #ag ( su* title is     
am5d$ by ins]t+ aft] ! item relat+ to   
section #agcj;,a ! foll[+ new item3     
#agcj;,b4 ,record+ obligations = c>e at 
non-,dep>tm5t facilities4  4  ,,iii ,o!r
 heal? c>e matt]s  #cja4 ,treatm5t (    

,dep>tm5t ( ,vet]ans ,affairs z         
p>ticipat+ provid] = recov]y ( co/s (   
c]ta9 m$ical c>e ,section #agbi7;f7 (   
title #ch1 ,unit$ ,/ates ,code1 is am5d$
 by /rik+ 7f7 ,no law & ins]t+ ! foll[+3
  7f7 7#a7 ,9 ! case ( a vet]an :o is   
entitl$ to c>e 7or paym5t ( ! exp5ses ( 
c>e7 "u a heal?-plan contract1 =        
purposes ( reimbursem5t = provid+ c>e or
 s]vices "u ?is *apt] to t vet]an = a   
non-s]vice-connect$ disability describ$ 
9 subp>agraph 7,d7 or 7,e7 ( subsection 
7a77#b71 ! ,dep>tm5t %all be treat$ z a 
p>ticipat+ provid] "u t heal?-plan      
contract4  7#b7 ,no law  4  #cjb4       
,prim>y c>e provid]s = vet]ans enroll$ 9
 pati5t enrollm5t sy/em ( ,dep>tm5t (   
,vet]ans ,affairs  7a7 ,9 g5]al         
,sub*apt] ,i ( *apt] #ag ( title #ch1   
,unit$ ,/ates ,code1 is am5d$ by ins]t+ 
aft] section #agje ! foll[+ new section3
  #agje;,a4 ,managem5t ( heal? c>e3     
prim>y c>e provid]  7a7 ,9 g5]al ,!     
,secret>y %all1 to ! maximum ext5t      
possible1 assign ea* vet]an enroll$ 9 ! 

sy/em ( annual pati5t enrollm5t e/abli%$
 & op]at$ "u section #agje ( ?is title a
 full-"t prim>y c>e provid] t meets !   
foll[+ crit]ia3  7#a7 ,except z provid$ 
9 p>agraph 7#b71 locat$ n m ?an #dj     
miles driv+ di/ance f ! resid5ce ( !    
vet]an4  7#b7 ,if ! vet]an resides 9 a  
,/ate )\t a m$ical facility ( !         
,dep>tm5t t provides hospital c>e1      
em]g5cy m$ical s]vices1 & surgical c>e1 
locat$ n m ?an #bj miles driv+ di/ance f
 ! resid5ce ( ! vet]an4  7#c7 ,locat$   
su* t ! vet]an is n requir$ to travel by
 air1 boat1 or f]ry or ov]come an       
unusual or excessive burd5 to access !  
prim>y c>e provid]4  7b7 ,types (       
provid]s ,9 c>ry+ out ?is section1 !    
,secret>y may select f among prim>y c>e 
provid]s t are heal? c>e provid]s ( !   
,dep>tm5t & prim>y c>e provid]s t are n 
heal? c>e provid]s ( ! ,dep>tm5t4  4    
7b7 ,cl]ical am5dm5t ,! table ( sections
 at ! beg9n+ ( *apt] #ag ( su* title is 
am5d$ by ins]t+ aft] ! item relat+ to   
section #agje ! foll[+ new item3        

#agje;,a4 ,managem5t ( heal? c>e3 prim>y
 c>e provid]4  4