,,ii #aadth ,,congress #b;d ,session ,s4 #cdja ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #bg1 #bjaf ,mr4 ,crapo introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,a ,,bill ,to amend title #ch1 ,united ,states ,code1 to consolidate and expand the provision of health care to veterans through non-,department of ,veterans ,affairs health care providers1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,improving ,veterans ,care in the ,community ,act of #bjaf4 #b4 ,sense of ,congress ,it is the sense of ,congress that-- 7#a7 the ,department of ,veterans ,affairs should remain the primary means by which eligible veterans access health care2 7#b7 the ,veterans ,health ,administration needs a simple tool by which it can send veterans into the community to receive health care when appropriate2 and 7#c7 it is appropriate to send veterans into the community for health care when-- 7,a7 it is in the best medical interest of the veteran2 7,b7 the veteran does not have access to a medical facility of the ,department without an undue travel burden2 7,c7 the nearest medical facility of the ,department does not provide the service the veteran needs and the veteran faces an undue travel burden to receive the service from another medical facility of the ,department2 or 7,d7 the ,secretary of ,veterans ,affairs determines that it is appropriate4 #c4 ,establishment of ,care in the ,community ,program of ,department of ,veterans ,affairs to consolidate and expand the provision of health care to veterans through non-,department of ,veterans ,affairs providers 7a7 ,establishment of program 7#a7 ,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 ,care in the ,community ,program 7a7 ,in general 7#a7 ,there is established a consolidated program to furnish care and services specified in subsection 7e7 to veterans through individuals and entities specified in subsection 7c71 including through the use of contracts or agreements entered into under this section to furnish such care and services4 ,such program may be referred to as the ,care in the ,community ,program4 7b7 ,requirement ,to receive care ,to receive care or services under this section1 a veteran must be enrolled in the patient enrollment system of the ,department established and operated under section #agje of this title4 7c7 ,individuals and entities specified ,individuals and entities 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 seq47 or the ,medicaid program under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq471 including any physician furnishing services under such a program4 7#b7 ,the ,department of ,defense1 including pursuant to agreements entered into under section #haaa of this title4 7#c7 ,the ,indian ,health ,service4 7#d7 ,institutions affiliated with the ,department under section #gcjb of this title4 7#e7 ,providers of care under the ,alaska ,native ,health ,care ,system4 7#f7 ,federally-qualified health centers 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#g7 ,any individual or entity with which the ,secretary has entered into a contract or agreement under section #haec of this title4 7#h7 ,any other individual or entity that meets criteria established by the ,secretary for purposes of this section4 7d7 ,eligibility for certain services 7#a7 7,a7 ,a veteran is eligible for hospital care and medical services under subsection 7e77#i7 if-- 7i7 the veteran does not live within #dj miles of a medical facility of the ,department1 including a community-based outpatient clinic2 7ii7 the veteran requires care or services that are not available at any medical facility of the ,department1 including a community-based outpatient clinic1 within #dj miles from the residence of the veteran2 7iii7 the veteran resides-- 7,i7 in a ,state without a medical facility of the ,department that provides-- 7aa7 hospital care2 7bb7 emergency medical services2 and 7cc7 surgical care rated by the ,secretary as having a surgical complexity of standard2 and 7,,ii7 more than #bj miles from a medical facility of the ,department described in subclause 7,i72 7iv7 the veteran-- 7,i7 resides in a location1 other than a location in ,guam1 ,american ,samoa1 or the ,republic of the ,philippines1 that is within #dj miles of a medical facility of the ,department1 including a community-based outpatient clinic2 and 7,,ii7 7aa7 is required to travel by air1 boat1 or ferry to reach each medical facility described in subclause 7,i7 that is within #dj miles of the residence of the veteran2 or 7bb7 faces an unusual or excessive burden in traveling to such a medical facility of the ,department based on-- 7,,aa7 geographical challenges2 7,,bb7 environmental factors1 such as roads that are not accessible to the general public1 traffic1 or hazardous weather2 7,,cc7 a medical condition that impacts the ability to travel2 or 7,,dd7 other factors1 as determined by the ,secretary2 7v7 the veteran would be required to wait longer than a period specified by the ,secretary to receive hospital care or medical services from the ,department2 or 7vi7 a health care provider of the ,department determines that it is in the medical interest of the veteran to access hospital care or medical services outside of the ,department4 7,b7 ,any distance specified under subparagraph 7,a7 shall be calculated based on distance traveled4 7,c7 ,the period specified by the ,secretary under subparagraph 7,a77v7 shall be #cj days unless the ,secretary-- 7i7 prescribes regulations specifying a different period1 which may include a different period for each area of specialty care2 and 7ii7 publishes such different period or periods in the ,federal ,register and on an ,internet ,web site of the ,department4 7,d7 ,veterans who meet eligibility criteria set forth under 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 7commonly known as ,project ,arch71 as in effect on the day before the termination of such program1 are eligible for care and services under subsection 7e77#i74 7#b7 7,a7 ,a veteran is eligible for reimbursement for emergency treatment furnished under subsection 7e77#ae7 at a non-,department facility-- 7i7 if the veteran is an active ,department health-care participant who is personally liable for emergency treatment furnished the veteran in a non-,department facility1 for any emergency treatment furnished such veteran2 or 7ii7 if the treatment was for-- 7,i7 an adjudicated service-connected disability2 7,,ii7 a non-service-connected disability associated with and held to be aggravating a service-connected disability2 7,,iii7 any disability of a veteran if the veteran has a total disability permanent in nature from a service-connected disability2 or 7,,iv7 any illness1 injury1 or dental condition of a veteran who-- 7aa7 is a participant in a vocational rehabilitation program 7as defined in section #caja7i7 of this title72 and 7bb7 is medically determined to have been in need of care or treatment to make possible the veteran's entrance into a course of training1 or prevent interruption of a course of training1 or hasten the return to a course of training which was interrupted because of such illness1 injury1 or dental condition4 7,b7 ,a veteran is an active ,department health-care participant if the veteran received care under this chapter within the #bd-month period preceding the furnishing of such emergency treatment4 7,c7 ,a veteran is personally liable for emergency treatment furnished the veteran in a non-,department facility if the veteran-- 7i7 is financially liable to the provider of emergency treatment for that treatment2 7ii7 has no entitlement to care or services under a health-plan contract 7determined1 in the case of a health-plan contract as defined in subsection 7j77#b77;,b7 or 7j77#b77;,c71 without regard to any requirement or limitation relating to eligibility for care or services from any department or agency of the ,united ,states72 and 7iii7 has no other contractual or legal recourse against a third party that would1 in whole1 extinguish such liability to the provider4 7e7 ,care and services ,care and services specified in this subsection are the following3 7#a7 ,hospital care or medical services furnished to a veteran for the treatment of-- 7,a7 a service-connected disability2 7,b7 a disability for which a veteran was discharged or released from the active military1 naval1 or air service2 or 7,c7 a disability of a veteran who has a total disability permanent in nature from a service-connected disability4 7#b7 ,medical services for the treatment of any disability of-- 7,a7 a veteran described in section #agaj7;a77#a77;,b7 of this title2 7,b7 a veteran who-- 7i7 has been furnished hospital care1 nursing home care1 domiciliary care1 or medical services2 and 7ii7 requires medical services to complete treatment incident to such care or services2 or 7,c7 a veteran described in section #agaj7;a77#b77;,e7 of this title1 or a veteran who is in receipt of increased pension1 or additional compensation or allowances based on the need of regular aid and attendance or by reason of being permanently housebound 7or who1 but for the receipt of retired pay1 would be in receipt of such pension1 compensation1 or allowance71 if the ,secretary has determined1 based on an examination by a physician employed by the ,department 7or1 in areas where no such physician is available1 by a physician carrying out such function under a contract or fee arrangement71 that the medical condition of such veteran precludes appropriate treatment in ,department facilities4 7#c7 ,hospital care or medical services in a non-,department facility for the treatment of medical emergencies which pose a serious threat to the life or health of a veteran receiving medical services in a ,department facility or nursing home care under section #agbj of this title until such time following the furnishing of care in the non-,department facility as the veteran can be safely transferred to a ,department facility4 7#d7 ,hospital care for women veterans4 7#e7 ,hospital care1 or medical services that will obviate the need for hospital admission1 for veterans in a ,state 7other than the ,commonwealth of ,puerto ,rico7 not contiguous to the contiguous ,states1 except that the annually determined hospital patient load and incidence of the furnishing of medical services to veterans hospitalized or treated at the expense of the ,department in ,government and non-,department facilities in each such noncontiguous ,state shall be consistent with the patient load or incidence of the furnishing of medical services for veterans hospitalized or treated by the ,department within the #dh contiguous ,states and the ,commonwealth of ,puerto ,rico4 7#f7 ,diagnostic services necessary for determination of eligibility for1 or of the appropriate course of treatment in connection with1 furnishing medical services at independent ,department outpatient clinics to obviate the need for hospital admission4 7#g7 ,outpatient dental services and treatment1 and related dental appliances1 for a veteran described in section #agab7;a77#a77;,f7 of this title4 7#h7 ,diagnostic services 7on an inpatient or outpatient basis7 for observation or examination of a person to determine eligibility for a benefit or service under laws administered by the ,secretary4 7#i7 ,hospital care and medical services for veterans described in subsection 7d77#a74 7#aj7 ,hospital care and medical services1 including counseling and related mental health services under section #agab;,a1 for veterans meeting eligibility criteria for such care and services under the ,patient-,centered ,community ,care program of the ,department1 as in effect on the day before the effective date under section #c7;j77#b7 of the ,improving ,veterans ,care in the ,community ,act of #bjaf4 7#aa7 ,hospital care and medical services for veterans at medical facilities of the ,indian ,health ,service or under the ,tribal ,health ,program pursuant to sharing agreements entered into between the ,department and the ,indian ,health ,service1 ,indian tribes1 or tribal organizations4 7#ab7 ,hospital care and medical services for veterans at medical facilities of the ,department of ,defense pursuant to sharing agreements entered into between the ,department of ,veterans ,affairs and the ,department of ,defense4 7#ac7 ,hospital care and medical services for veterans at other non-,department facilities pursuant to sharing agreements entered into between the ,department of ,veterans ,affairs and such facilities4 7#ad7 ,hospital care and medical services for veterans at institutions affiliated with the ,department under section #gcjb of this title pursuant to contracts entered into with such institutions4 7#ae7 ,reimbursement for payment made by veterans described in subsection 7d77#b71 or on behalf of such veterans1 for emergency treatment furnished such veterans in non-,department facilities4 7f7 ,referral for services 7#a7 ,except as provided in paragraph 7#b71 a veteran is required to obtain a referral from a primary care provider of the ,department to receive specialty care services under this section4 ,any such referral shall be reviewed by the director of the medical facility at which the primary care physician is located4 7#b7 7,a7 ,a veteran described in any of clauses 7i7 through 7v7 of subsection 7d77#a77;,a7 is not required to obtain a referral for specialty care services furnished under subsection 7e77#i74 7,b7 ,in the case of a veteran described in subparagraph 7,a71 the ,secretary1 through the ,non-,,va ,care ,coordination ,program of the ,department1 shall notify the primary care provider of the veteran of the specialty care appointment and ensure that the primary care provider receives materials from the specialty care provider necessary to update the medical record of the veteran as appropriate4 7g7 ,payment rates 7#a7 ,subject to paragraph 7#b71 the ,secretary shall establish uniform rates for payment or reimbursement for care and services under this section4 7#b7 ,in entering into contracts or agreements under this section with individuals and entities specified in subsection 7c71 the ,secretary shall-- 7,a7 negotiate rates for the furnishing of care and services under this section2 and 7,b7 reimburse the individual or entity for such care and services at the rates negotiated pursuant to subparagraph 7,a7 as provided in such contract or agreement4 7#c7 7,a7 ,except as provided in subparagraph 7,b71 rates negotiated under paragraph 7#b77;,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 services4 7,b7 7i7 ,the ,secretary may negotiate a rate that is more than the rate paid by the ,united ,states as described in subparagraph 7,a7 with respect to the furnishing of care or services under this section to a veteran who resides in a highly rural area4 7ii7 ,with respect to furnishing care or services under this section in ,alaska1 the ,alaska ,fee ,schedule of the ,department of ,veterans ,affairs shall be followed1 except for when another payment agreement1 including a contract or provider agreement1 is in place4 7iii7 ,with respect to furnishing care or services under this section in a ,state with an ,all-,payer ,model ,agreement under section #ahad7;b77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77#c77 that became effective on ,january #a1 #bjad1 the ,medicare payment rates under subparagraph 7,a7 shall be calculated based on the payment rates under such agreement4 7iv7 ,in this subparagraph1 the term highly rural area means an area located in a county that has fewer than seven individuals residing in that county per square mile4 7h7 ,administration 7#a7 ,except as provided in paragraph 7#b71 the ,secretary shall be responsible for administering the ,care in the ,community ,program through the ,non-,,va ,care ,coordination ,program of the ,department4 7#b7 ,the ,non-,,va ,care ,coordination ,program1 through each medical center of the ,department1 shall be responsible for handling the day-to-day administration of the ,care in the ,community ,program1 including finding providers1 scheduling appointments1 paying providers1 and disseminating information to providers4 7i7 ,outreach ,the ,non-,,va ,care ,coordination ,program1 through each medical center of the ,department1 shall be responsible for conducting outreach to health care providers and veterans located in the area covered by the medical center regarding care and services available under the ,care in the ,community ,program4 7j7 ,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 ,department or other ,federal facilities are not feasibly available and an attempt to use them beforehand would not be reasonable2 7,b7 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,c7 until-- 7i7 such time as the veteran can be transferred safely to a ,department facility or other ,federal facility and such facility is capable of accepting such transfer2 or 7ii7 such time as a ,department facility or other ,federal facility accepts such transfer if-- 7,i7 at the time the veteran could have been transferred safely to a ,department facility or other ,federal facility1 no ,department facility or other ,federal facility 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 other ,federal facility4 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 that ,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 4 7#b7 ,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 ,care in the ,community ,program4 4 7b7 ,implementation 7#a7 ,initial implementation 7,a7 ,in general ,except as provided in subparagraph 7,b71 during the one-year period beginning on the effective date specified in subsection 7j77#a71 the ,secretary of ,veterans ,affairs shall implement the ,care in the ,community ,program under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a71 by prioritizing the use of such ,program in areas where there are medical facilities of the ,department that are experiencing issues with quality of care or lack of capacity4 7,b7 ,exception for reimbursement for emergency care ,reimbursement for payment made by veterans1 or on behalf of such veterans1 for emergency treatment furnished such veterans in non-,department facilities under section #agjc;,a7e77#ae7 of such title1 as so added1 shall be implemented in all areas on and after the effective date specified in subsection 7j77#a74 7#b7 ,full implementation 7,a7 ,in general ,on and after the end of the one-year period described in paragraph 7#a77;,a71 the ,secretary shall implement the ,care in the ,community ,program under section #agjc;,a of such title1 as so added1 in all areas4 7,b7 ,report ,if the ,secretary is unable to implement the ,care in the ,community ,program under section #agjc;,a of such title1 as so added1 in all areas as of the date that is two years after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on why the ,secretary is unable to implement such program in all areas4 7c7 ,funding ,amounts required to carry out the ,care in the ,community ,program under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a71 shall be derived from the ,medical ,services account of the ,department of ,veterans ,affairs or the ,veterans ,choice ,fund under section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note71 as amended by section #d of this ,act4 7d7 ,treatment of other programs1 contracts1 and agreements 7#a7 ,in general ,any contract1 sharing agreement1 or other agreement entered into under any provision of law that authorizes individuals eligible for health care from the ,department of ,veterans ,affairs to receive such care at facilities that are not facilities of the ,department of ,veterans ,affairs shall be administered under the ,care in the ,community ,program under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a71 on and after the effective date specified in subsection 7j77#b74 7#b7 ,treatment of ,patient-,centered ,community ,care program ,on and after the effective date specified in subsection 7j77#b71 the ,secretary of ,veterans ,affairs may not carry out the ,patient-,centered ,community ,care program of the ,department of ,veterans ,affairs 7commonly known as ,,pc#c7 and shall ensure that beneficiaries under such program are able to receive care under the ,care in the ,community ,program under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a74 7e7 ,patient advocacy ,section #gcji;,a of title #ch1 ,united ,states ,code1 is amended-- 7#a7 by redesignating subsections 7e7 and 7f7 as subsections 7f7 and 7g71 respectively2 7#b7 by inserting after subsection 7d7 the following new subsection 7e73 7e7 ,education on non-,department care ,the ,director shall develop and administer a program of education on the ,care in the ,community ,program under section #agjc;,a of this title that ensures veterans understand-- 7#a7 how the ,care in the ,community ,program works2 7#b7 how veterans become eligible for the ,care in the ,community ,program2 and 7#c7 all issues regarding payment for care under the ,care in the ,community ,program1 including when the ,department is the primary payer and when the ,department is not the primary payer and the veteran may have to pay out of pocket4 4 7f7 ,extension of existing program ,subsection 7p7 of section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended to read as follows3 7p7 ,authority ,to furnish care and services ,the ,secretary may not use the authority under this section to furnish care and services after the date on which the ,secretary submits to ,congress the certification described in section #c7;j77#b7 of the ,improving ,veterans ,care in the ,community ,act of #bjaf4 4 7g7 ,report on administrators of ,choice ,program 7#a7 ,in general ,not later than #ahj days after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on administrators used by the ,department of ,veterans ,affairs to administer section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7#b7 ,elements ,the report required by paragraph 7#a7 shall include the following3 7,a7 ,an assessment of the performance of administrators1 including-- 7i7 an examination of the ability of administrators to schedule appointments1 reimburse providers in a timely manner1 and meet the performance standards established by their contract with the ,department of ,veterans ,affairs2 and 7ii7 an assessment of the satisfaction of veterans with the work of administrators4 7,b7 ,an assessment of the overlap of the work of administrators with the work of employees of the ,department1 especially employees at medical centers and community-based outpatient clinics and employees of the ,non-,,va ,care ,coordination ,program4 7,c7 ,an assessment of the resources needed by the ,department to function without administrators in implementing the ,care in the ,community ,program under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a74 7h7 ,repeal of superseded authority for contracts for care in non-,department facilities 7#a7 ,in general ,section #agjc of title #ch1 ,united ,states ,code1 is repealed4 7#b7 ,conforming amendments 7,a7 ,dental care ,section #agab7;a7 of such title is amended-- 7i7 in paragraph 7#c71 by striking under clause 7#a71 7#b71 or 7#e7 of section #agjc7;a7 of this title and inserting under section #agjc;,a of this title2 and 7ii7 in paragraph 7#d77;,a71 in the first sentence1 by striking section #agjc of this title each place it appears and inserting section #agjc;,a of this title4 7,b7 ,readjustment counseling ,section #agab;,a7e77#a7 of such title is amended by striking sections #agjc7;a77#b7 and #agaj7;a77#a77;,b7 and inserting sections #agjc;,a and #agaj7;a77#a77;,b74 7,c7 ,death in ,department facility ,section #bcjc7;a77#b77;,b77i7 of such title is amended by striking in accordance with section #agjc and inserting under section #agjc;,a4 7,d7 ,medicare provider agreements ,section #ahff7;a77#a77,l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is amended by striking under section #agjc of title #ch and inserting under section #agjc;,a of title #ch4 7i7 ,repeal of superseded authority for emergency treatment reimbursement 7#a7 ,non-service connected 7,a7 ,in general ,section #agbe of such title is repealed4 7,b7 ,conforming amendments 7i7 ,medical care collections fund ,section #agbi;,a7b7 of such title is amended-- 7,i7 by striking paragraph 7#e72 and 7,,ii7 by redesignating paragraphs 7#f7 through 7#aj7 as paragraphs 7#e7 through 7#i71 respectively4 7ii7 ,medical care for survivors and dependents ,section #agha7;a77#d7 of such title is amended by striking section #agbe7;f7 and inserting section #agjc7;j74 7iii7 ,health care for family members of veterans stationed at ,camp ,lejeune1 ,north ,carolina ,section #aghg7;b77#c7 of such title is amended by striking section #agbe7;f7 and inserting section #agjc7;j74 7#b7 ,service connected ,section #agbh of such title is repealed4 7j7 ,effective dates 7#a7 ,community ,care ,program ,the amendments made by subsections 7a71 7d71 and 7i7 shall take effect on the date that is one year after the date of the enactment of this ,act4 7#b7 ,repeal of superseded authority 7,a7 ,in general ,the amendments made by subsection 7h7 shall take effect on the date on which the ,secretary of ,veterans ,affairs certifies to ,congress that the ,secretary is fully implementing the ,care in the ,community ,program under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a74 7,b7 ,publication ,the ,secretary shall publish the date specified in subparagraph 7,a7 in the ,federal ,register not later than #ij days before such date4 #d4 ,authorization of use of certain amounts appropriated to the ,veterans ,choice ,fund for other non-,department of ,veterans ,affairs care ,section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #abh ,stat4 #ahja7 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 following 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 non-,department provider programs other than the program 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 section shall be in addition to amounts made available to the ,secretary in the ,medical ,services account of the ,department of ,veterans ,affairs4 7#d7 ,definitions ,in this subsection3 7,a7 ,the term non-,department facilities has the meaning given that term in section #agja of title #ch1 ,united ,states ,code4 7,b7 ,the term non-,department provider programs has the meaning given that term in section #djjb7;d7 of the ,,va ,budget and ,choice ,improvement ,act 7,public ,law #aad-da2 #abi ,stat4 #dfb74 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 #e4 ,interdisciplinary panel on development of clinical appeals process for the ,department of ,veterans ,affairs 7a7 ,in general ,the ,secretary of ,veterans ,affairs shall establish an interdisciplinary panel to assist the ,secretary in developing a new clinical appeals process for resolving disputes regarding health care furnished under the laws administered by the ,secretary of ,veterans ,affairs1 including health care furnished under the ,care in the ,community ,program under section #agjc;,a of title #ch1 ,united ,states ,code1 as added by section #c7;a74 7b7 ,duties ,the duties of the interdisciplinary panel established under subsection 7a7 are the following3 7#a7 ,to create one process throughout the ,veterans ,health ,administration for resolving clinical disputes4 7#b7 ,to ensure that such process provides veterans with the ability to have an external review at his or her discretion4 7#c7 ,to ensure that such process is as comprehensive and fair as processes provided by private health insurers and other ,federal agencies4 7c7 ,report ,not later than one year after the date of the enactment of this ,act1 the ,secretary shall submit to ,congress a report on the activities of the interdisciplinary panel under this section4 #f4 ,comptroller ,general reports on the ,department of ,veterans ,affairs 7a7 ,report on clinical operations of ,veterans ,health ,administration ,not later than one year after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the clinical operations of the ,veterans ,health ,administration that includes an assessment of the following3 7#a7 ,how such clinical operations can be enhanced4 7#b7 ,what the ,secretary of ,veterans ,affairs can do to ensure that highly trained clinical staff of the ,department of ,veterans ,affairs are able to perform at the top of their license and are not performing tasks that should be done by support staff4 7#c7 ,what the ,secretary can do to improve the hiring1 retaining1 and training of medical support assistants of the ,department4 7b7 ,report on travel benefits program of ,department ,not later than one year after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the travel benefits program of the ,department under sections #aaa and #aaa;,a of title #ch1 ,united ,states ,code1 that includes an assessment of the following3 7#a7 ,how such program can be improved to ensure that veterans are reimbursed for travel in a timely manner4 7#b7 ,what the ,secretary can do to speed up the reimbursement process while protecting against fraud1 waste1 and abuse4 7#c7 ,whether there should be changes made to eligibility for such program4 7c7 ,report on ,office of ,congressional and ,legislative ,affairs of ,department ,not later than one year after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the structure and management of the ,office of ,congressional and ,legislative ,affairs of the ,department1 including an assessment of what the ,secretary can do to enable the ,office to provide more timely1 complete responses to requests from ,congress4 7d7 ,report on payment for non-,department care ,not later than one year after the date of the enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on payment by the ,department for health care furnished to veterans through non-,department health care providers1 including an assessment of the following3 7#a7 ,when the ,department should be the primary payer for such care and when the ,department should be the secondary payer for such care4 7#b7 ,how payment by the ,department for such care should function with coverage under private insurance1 coverage under the ,medicare program1 and other health coverage options4 #g4 ,establishment of ,payment and ,access ,commission for ,veterans ,health ,administration 7a7 ,establishment ,subchapter ,,ii of chapter #gc of title #ch1 ,united ,states ,code1 is amended by inserting after section #gccj;,a the following new section3 #gccj;,b4 ,payment and ,access ,commission 7a7 ,establishment ,there is established in the ,veterans ,health ,administration a ,payment and ,access ,commission 7in this section referred to as the ,,vhapac74 7b7 ,membership 7#a7 ,the ,,vhapac shall be composed of #ag members appointed by the ,comptroller ,general of the ,united ,states4 7#b7 7,a7 ,the membership of ,,vhapac shall include the following3 7i7 ,veterans who have received care from the ,veterans ,health ,administration4 7ii7 ,individuals with national recognition for their expertise with respect to-- 7,i7 ,federal health programs2 7,,ii7 health finance and economics2 7,,iii7 actuarial science2 7,,iv7 health plans and integrated delivery systems2 7,v7 reimbursement for health care2 or 7,,vi7 health information technology4 7iii7 ,providers of health services1 public health1 and other related fields4 7iv7 ,physicians and other health professionals4 7v7 ,individuals with expertise in the delivery of health services4 7,b7 ,members of the ,,vhapac shall be appointed in a manner to provide a mix of different professions1 broad geographic representation1 and a balance between urban and rural representation4 7,c7 ,members described in clauses 7iv7 and 7v7 of subparagraph 7,a7 shall include representatives of veterans1 including veterans with disabilities1 and caregivers4 7,d7 ,individuals who are directly involved in the provision1 or management of the delivery1 of items and services furnished by the ,department shall not constitute a majority of the membership of the ,,vhapac4 7,e7 ,the ,comptroller ,general of the ,united ,states shall establish a system for public disclosure by members of the ,,vhapac of financial and other potential conflicts of interest relating to such members4 7,f7 ,members of the ,,vhapac shall be treated as employees of ,congress for purposes of applying title ,i of the ,ethics in ,government ,act of #aigh 7#e ,u4,s4,c4 ,app474 7#c7 7,a7 ,the terms of members of the ,,vhapac shall be for three years except that the ,comptroller ,general of the ,united ,states shall designate staggered terms for the members first appointed4 7,b7 ,any member appointed to fill a vacancy occurring before the expiration of the term for which the member's predecessor was appointed shall be appointed only for the remainder of that term4 ,a member may serve after the expiration of that member's term until a successor has taken office4 ,a vacancy in the ,,vhapac shall be filled in the manner in which the original appointment was made4 7#d7 7,a7 ,while serving on the business of the ,,vhapac 7including travel time71 a member of the ,,vhapac shall be entitled to compensation at the per diem equivalent of the rate provided for level ,,iv of the ,executive ,schedule under section #ecae of title #e4 7,b7 ,while serving on the business of the ,,vhapac 7including travel time7 away from home and the member's regular place of business1 a member may be allowed travel expenses1 as authorized by the ,chairman of the ,,vhapac4 7#e7 ,the ,comptroller ,general of the ,united ,states shall designate a ,chairman and ,vice ,chairman of the ,,vhapac1 at the time of appointment of each such individual as a member of the ,,vhapac1 for the term of appointment of such individual1 except that in the case of vacancy of the ,chairmanship or ,vice ,chairmanship1 the ,comptroller ,general may designate another member for the remainder of the term of the ,chairman or ,vice ,chairman1 as the case may be4 7#f7 ,the ,,vhapac shall meet at the call of the ,chairman4 7c7 ,duties 7#a7 ,the ,,vhapac shall-- 7,a7 review policies of the ,veterans ,health ,administration affecting access of veterans to health care1 including topics affected by the ,care in the ,community ,program under section #agjc;,a of this title2 7,b7 make recommendations to ,congress1 the ,secretary1 and ,states concerning such access policies2 and 7,c7 by not later than ,march #ae of each year 7beginning with #bjah71 submit to ,congress a report containing-- 7i7 the results of reviews conducted under subparagraph 7,a72 7ii7 recommendations made under subparagraph 7,b72 and 7iii7 an examination of the implications of changes in health care delivery in the ,united ,states and in the market for health care services on health care furnished under the laws administered by the ,secretary4 7#b7 ,specifically1 the ,,vhapac shall review and assess the following3 7,a7 ,payment policies regarding payment by the ,secretary for health care furnished under the laws administered by the ,secretary by non-,department providers1 including-- 7i7 the factors affecting expenditures for the efficient provision of items and services in different sectors1 including the process for updating payments to medical1 dental1 and health professionals1 hospitals1 residential and long-term care providers1 providers of home and community based services1 ,federally-qualified health centers and rural health clinics 7as defined in section #aije7l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l7771 managed care entities1 and providers of other covered items and services2 7ii7 payment methodologies2 and 7iii7 the relationship of such factors and methodologies to access and quality of care for veterans receiving care under the laws administered by the ,secretary 7including how such factors and methodologies enable such veterans to obtain the services for which they are eligible1 affect provider supply1 and affect providers that serve a disproportionate share of low-income and other vulnerable populations74 7,b7 ,eligibility policies for receiving care under the laws administered by the ,secretary1 including the ,care in the ,community ,program under section #agjc;,a of this title4 7,c7 ,enrollment and retention processes for receiving care under the laws administered by the ,secretary4 7,d7 ,policies of the ,department relating to the quality of care furnished under the laws administered by the ,secretary4 7,e7 ,the effect of payment policies described in subparagraph 7,a71 especially under the ,care in the ,community ,program under section #agjc;,a of this title1 on access to items and services for veterans and the implications of changes in health care delivery in the ,united ,states and in the general market for health care items and services on such payment policies4 7,f7 ,the interaction of policies of the ,department1 including under the ,care in the ,community ,program1 with the ,medicaid and ,medicare programs1 private insurance1 and other forms of health care coverage such as the ,,tricare program 7as defined in section #ajgb of title #aj71 including with respect to how such interactions affect access to services1 payments1 and dual eligible individuals4 7,g7 ,the effect of policies of the ,department on access to covered items and services1 including policies relating to transportation and preventive1 acute1 and long-term services and supports4 7#c7 ,the ,,vhapac shall-- 7,a7 review national data regarding health care furnished under the laws administered by the ,secretary2 and 7,b7 submit reports and recommendations to ,congress and the ,secretary1 including recommendations that do not require changes in law4 7#d7 7,a7 ,the ,,vhapac shall create an early-warning system to identify provider shortage areas1 as well as other factors that adversely affect1 or have the potential to adversely affect1 access to care by1 or the health care status of1 veterans eligible for health care under the laws administered by the ,secretary4 7,b7 ,the ,,vhapac shall include in the annual report required under paragraph 7#a77;,c7 a description of all areas and factors identified under subparagraph 7,a7 with respect to the period addressed in the report4 7#e7 7,a7 ,if the ,secretary submits to ,congress 7or a committee of ,congress7 a report that is required by law and that relates to policies relating to access to health care under the laws administered by the ,secretary1 including with respect to payment policies for non-,department providers1 the ,secretary shall transmit a copy of the report to the ,,vhapac4 ,the ,,vhapac shall review the report and1 not later than #ahj days after the date of submittal by the ,secretary of the report to ,congress1 shall submit to the appropriate committees of ,congress and the ,secretary written comments on such report4 ,such comments may include such recommendations as the ,,vhapac determines appropriate4 7,b7 ,the ,,vhapac shall review regulations of the ,department relating to the provision of health care and may comment through submission of a report to the appropriate committees of ,congress and the ,secretary on any such regulations that affect access1 quality1 or efficiency of health care under the laws administered by the ,secretary4 7#f7 7,a7 ,the ,,vhapac shall consult periodically with the chairmen and ranking minority members of the appropriate committees of ,congress regarding the agenda of the ,,vhapac and progress towards achieving that agenda4 7,b7 ,the ,,vhapac may conduct additional reviews and submit additional reports to the appropriate committees of ,congress from time to time on such topics relating to the policies and programs of the ,veterans ,health ,administration as may be requested by the chairmen and ranking minority members of such committees and as the ,,vhapac determines appropriate4 7#g7 ,the ,,vhapac shall transmit to the ,secretary a copy of each report submitted under this subsection and shall make such reports available to the public4 7#h7 ,with respect to each recommendation contained in a report submitted under paragraph 7#a77;,c71 each member of the ,,vhapac shall vote on the recommendation1 and the ,,vhapac shall include1 by member1 the results of that vote in the report containing the recommendation4 7#i7 ,before making any recommendations under this section1 the ,,vhapac shall examine the budget consequences of such recommendations1 directly or through consultation with appropriate expert entities1 and shall submit with any recommendations a report on the consequences to the ,federal ,government of the recommendations4 7#aj7 7,a7 ,the ,,vhapac shall consult with the ,medicare ,payment ,advisory ,commission established under section #ahje of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#f7 in carrying out its duties under this section1 as the ,,vhapac determines appropriate4 7,b7 ,the ,,vhapac and the ,medicare ,payment ,advisory ,commission shall have access to deliberations and records of the other such entity1 respectively1 upon the request of the other such entity4 7#aa7 ,the ,,vhapac shall regularly consult with veterans service organizations in carrying out its duties under this section1 including with respect to developing processes for carrying out such duties1 and shall ensure that input from veterans service organizations is taken into account and represented in recommendations and reports prepared by the ,,vhapac4 7#ab7 ,the authority of the ,,vhapac to make recommendations under this section shall not affect1 or be considered to duplicate1 the authority of the ,secretary to carry out ,federal responsibilities with respect to programs of the ,veterans ,health ,administration4 7#ac7 ,in this subsection3 7,a7 ,the term appropriate committees of ,congress means the ,committee on ,veterans' ,affairs of the ,senate and the ,committee on ,veterans' ,affairs of the ,house of ,representatives4 7,b7 ,the term veterans service organization means an organization recognized by the ,secretary for the representation of veterans under section #eijb of this title4 7d7 ,personnel 7#a7 ,subject to such review as the ,comptroller ,general of the ,united ,states determines necessary to assure the efficient administration of the ,,vhapac1 the ,,vhapac may-- 7,a7 employ and fix the compensation of an ,executive ,director 7subject to the approval of the ,comptroller ,general7 and such other personnel as may be necessary to carry out the duties of the ,,vhapac 7without regard to the provisions of title #e governing appointments in the competitive service72 7,b7 seek such assistance and support as may be required in the performance of the duties of the ,,vhapac from appropriate ,federal and ,state departments and agencies2 7,c7 enter into contracts or make other arrangements as may be necessary for the conduct of the work of the ,,vhapac 7without regard to section #faja of title #da72 7,d7 make advance1 progress1 and other payments which relate to the work of the ,,vhapac2 7,e7 provide transportation and subsistence for persons serving without compensation2 and 7,f7 prescribe such rules and regulations as the ,,vhapac determines necessary with respect to the internal organization and operation of the ,,vhapac4 7#b7 7,a7 ,for purposes of pay 7other than pay of members of the ,,vhapac7 and employment benefits1 rights1 and privileges1 all personnel of the ,,vhapac shall be treated as if they were employees of the ,united ,states ,senate4 7,b7 ,physicians serving as personnel of the ,,vhapac may be provided a physician comparability allowance by the ,,vhapac in the same manner as ,government physicians may be provided such an allowance by an agency under section #eidh of title #e1 and for such purpose subsection 7i7 of such section shall apply to the ,,vhapac in the same manner as it applies to the ,tennessee ,valley ,authority4 7e7 ,powers 7#a7 ,the ,,vhapac may secure directly from any ,federal agency information in the possession of that agency necessary to enable the ,,vhapac to carry out this section4 ,upon request of the ,chairman1 the head of that agency shall furnish that information to the ,,vhapac on an agreed upon schedule4 7#b7 ,in order to carry out its functions1 the ,,vhapac shall-- 7,a7 if possible1 use existing information1 both published and unpublished1 collected and assessed either by personnel of the ,,vhapac or under other arrangements made in accordance with this section2 7,b7 carry out1 or award grants or contracts for1 original research and experimentation if existing information is inadequate2 and 7,c7 adopt procedures allowing any interested party to submit information for use by the ,,vhapac in making reports and recommendations4 7#c7 ,the ,comptroller ,general of the ,united ,states shall have unrestricted access to all deliberations1 records1 and nonproprietary data of the ,,vhapac1 immediately upon request4 7#d7 ,the ,,vhapac shall be subject to periodic audit by the ,comptroller ,general4 7f7 ,funding ,the ,,vhapac shall submit requests for appropriations in the same manner as the ,comptroller ,general of the ,united ,states submits requests for appropriations1 but amounts appropriated for the ,,vhapac shall be separate from amounts appropriated for the ,comptroller ,general4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #gc of such title is amended by inserting after the item relating to section #gccj;,a the following new item3 #gccj;,b4 ,payment and ,access ,commission4 4