,i  #aaeth ,,congress  #ast ,session    
,h4 ,r4 #daac  ,,in ,,the ,,house ,,of  
,,representatives  ,october #bd1        
#bjag,mr4 ,poliquin introduced the      
following bill2 which was referred to   
the ,committee on ,veterans' ,affairs   
,a ,,bill  ,to amend title #ch1 ,united 
,states ,code1 to allow the ,secretary  
of ,veterans ,affairs to enter into     
certain agreements with non-,department 
of ,veterans ,affairs health care       
providers if the ,secretary is not      
feasibly able to provide health care in 
facilities of the ,department or through
 contracts or sharing agreements1 and   
for other purposes4  #a4 ,short title   
,this ,act may be cited as the ,veterans
 ,access to ,long ,term ,care and       
,health ,services ,act4  #b4 ,purpose   
,the purpose of this ,act is--  7#a7 to 
maintain the access of veterans to      
high-quality hospital care1 medical     
services1 and extended care if that care
 is not available directly from the     
,department of ,veterans ,affairs2  7#b7

 to continue to allow the use by the    
,department of agreements covered by the
 ,federal ,acquisition ,regulation and  
agreements that are not covered by such 
regulation1 similar to those agreements 
used under the original ,medicare       
fee-for-service program 7,medicare      
,parts ,a and ,b71 if it is not         
practicable to contract for the care    
needed by veterans through an agreement 
covered by such regulation2  7#c7 to    
address the fact that individual health 
care providers1 especially smaller      
providers in rural areas1 may not be    
willing to accept veterans as patients  
when doing so would require the         
significant time and administrative     
requirements in connection with entering
 into agreements with the ,department   
that are covered by such regulation2    
7#d7 to address the deficiencies in     
current law regarding agreements entered
 into by the ,department that have      
raised legal issues2 and  7#e7 to ensure
 that agreements that are not covered by

 such regulation include robust terms   
and conditions that address the quality 
of health care for veterans1 oversight  
of the provision of such health care1   
and protections for taxpayers4  #c4     
,authorization of agreements between the
 ,department of ,veterans ,affairs and  
non-,department health care providers   
7a7 ,in general ,subchapter ,i of       
chapter #ag of title #ch1 ,united       
,states ,code1 is amended by adding     
after section #agjc the following new   
section3  #agjc;,a4 ,veterans ,care     
,agreements with certain health care    
providers  7a7 ,agreements ,to ,furnish 
,care  7#a7 ,if the ,secretary is not   
feasibly able to furnish hospital care1 
medical services1 or extended care under
 this chapter at facilities of the      
,department or under contracts or       
sharing agreements entered into under   
authorities other than this section1 the
 ,secretary may furnish such care and   
services by entering into agreements    
under this section with eligible        

providers that are certified under      
subsection 7c74 ,an agreement entered   
into under this section may be referred 
to as a ,veterans ,care ,agreement4     
7#b7 ,the ,secretary is not feasibly    
able to furnish care or services as     
described in paragraph 7#a7 if the      
,secretary determines that the medical  
condition of the veteran1 the travel    
involved1 the nature of the care or     
services required1 or a combination of  
those factors make the use of facilities
 of the ,department1 contracts1 or      
sharing agreements impracticable or     
inadvisable4  7#c7 ,eligibility of a    
veteran under this section for the care 
or services described in paragraph 7#a7 
shall be determined as if such care or  
services were furnished in a facility of
 the ,department and provisions of this 
title applicable to veterans receiving  
such care or services in a facility of  
the ,department shall apply to veterans 
receiving such care or services under   
this section4  7b7 ,eligible providers  

,for purposes of this section1 an       
eligible provider is one of the         
following3 7#a7 ,a provider of services 
that has enrolled and entered into a    
provider agreement under section        
#ahff7;a7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;cc7a774  7#b7 ,a   
physician or supplier that has enrolled 
and entered into a participation        
agreement under section #ahdb7;h7 of    
such ,act 7#db ,u4,s4,c4 #acieu7h774    
7#c7 ,a provider of items and services  
receiving payment under a ,state plan   
under title ,,xix of such ,act 7#db     
,u4,s4,c4 #acif et seq47 or a waiver of 
such a plan4  7#d7 ,a provider that is--
 7,a7 an ,aging and ,disability         
,resource ,center1 an area agency on    
aging1 or a ,state agency 7as defined in
 section #ajb of the ,older ,americans  
,act of #aife 7#db ,u4,s4,c4 #cjjb772 or
  7,b7 a center for independent living  
7as defined in section #gjb of the      
,rehabilitation ,act of #aigc 7#bi      
,u4,s4,c4 #gif;a774  7#e7 ,such other   

health care providers as the ,secretary 
considers appropriate for purposes of   
this section4  7c7 ,certification of    
eligible providers  7#a7 ,the ,secretary
 shall establish a process for the      
certification of eligible providers     
under this section that shall1 at a     
minimum1 set forth the following3  7,a7 
,procedures for the submittal of        
applications for certification and      
deadlines for actions taken by the      
,secretary with respect to such         
applications4  7,b7 ,standards and      
procedures for approval and denial of   
certification1 duration of              
certification1 revocation of            
certification1 and recertification4     
7,c7 ,procedures for assessing eligible 
providers based on the risk of fraud1   
waste1 and abuse of such providers      
similar to the level of screening under 
section #ahff7;j77#b77;,b7 of the       
,social ,security ,act 7#db ,u4,s4,c4   
#acie;cc7j77#b77;,b77 and the standards 
set forth under section #i4ajd of title 

#dh1 ,code of ,federal ,regulations1 or 
any successor regulation4  7#b7 ,the    
,secretary shall deny or revoke         
certification to an eligible provider   
under this subsection if the ,secretary 
determines that the eligible provider is
 currently--  7,a7 excluded from        
participation in a ,federal health care 
program 7as defined in section          
#aabh;,b7f7 of the ,social ,security    
,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777   
under section #aabh or #aabh;,a of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g and #acbj;a-#g;a72 or  7,b7  
identified as an excluded source on the 
list maintained in the ,system for      
,award ,management1 or any successor    
system4  7d7 ,terms of agreements ,each 
agreement entered into with an eligible 
provider under this section shall       
include provisions requiring the        
eligible provider to do the following3  
7#a7 ,to accept payment for care and    
services furnished under this section at
 rates established by the ,secretary for

 purposes of this section1 which shall  
be1 to the extent practicable1 the rates
 paid by the ,united ,states for such   
care and services to providers of       
services and suppliers under the        
,medicare program under title ,,xviii of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie et seq474  7#b7 ,to     
accept payment under paragraph 7#a7 as  
payment in full for care and services   
furnished under this section and to not 
seek any payment for such care and      
services from the recipient of such care
 and services4  7#c7 ,to furnish under  
this section only the care and services 
authorized by the ,department under this
 section unless the eligible provider   
receives prior written consent from the 
,department to furnish care or services 
outside the scope of such authorization4
  7#d7 ,to bill the ,department for care
 and services furnished under this      
section in accordance with a methodology
 established by the ,secretary for      
purposes of this section4  7#e7 ,not to 

seek to recover or collect from a       
health-plan contract or third party1 as 
those terms are defined in section #agbi
 of this title1 for any care or services
 for which payment is made by the       
,department under this section4  7#f7   
,to provide medical records for veterans
 furnished care or services under this  
section to the ,department in a         
timeframe and format specified by the   
,secretary for purposes of this section4
  7#g7 ,to meet such other terms and    
conditions1 including quality of care   
assurance standards1 as the ,secretary  
may specify for purposes of this        
section4  7e7 ,termination of agreements
  7#a7 ,an eligible provider may        
terminate an agreement with the         
,secretary under this section at such   
time and upon such notice to the        
,secretary as the ,secretary may specify
 for purposes of this section4  7#b7    
,the ,secretary may terminate an        
agreement with an eligible provider     
under this section at such time and upon

 such notice to the eligible provider as
 the ,secretary may specify for purposes
 of this section1 if the ,secretary--   
7,a7 determines that the eligible       
provider failed to comply substantially 
with the provisions of the agreement or 
with the provisions of this section and 
the regulations prescribed thereunder2  
7,b7 determines that the eligible       
provider is-- 7i7 excluded from         
participation in a ,federal health care 
program 7as defined in section          
#aabh;,b7f7 of the ,social ,security    
,act 7#db ,u4,s4,c4 #acbj;a-#g;b7f777   
under section #aabh or #aabh;,a of the  
,social ,security ,act 7#db ,u4,s4,c4   
#acbj;a-#g and #acbj;a-#g;a72 or  7ii7  
identified as an excluded source on the 
list maintained in the ,system for      
,award ,management1 or any successor    
system2  7,c7 ascertains that the       
eligible provider has been convicted of 
a felony or other serious offense under 
,federal or ,state law and determines   
that the continued participation of the 

eligible provider would be detrimental  
to the best interests of veterans or the
 ,department2 or  7,d7 determines that  
it is reasonable to terminate the       
agreement based on the health care needs
 of a veteran or veterans4  7f7         
,periodic review of certain agreements  
7#a7 ,not less frequently than once     
every two years1 the ,secretary shall   
review each ,veterans ,care ,agreement  
of material size entered into during the
 two-year period preceding the review to
 determine whether it is feasible and   
advisable to furnish the hospital care1 
medical services1 or extended care      
furnished under such agreement at       
facilities of the ,department or through
 contracts or sharing agreements entered
 into under authorities other than this 
section4  7#b7  7,a7 ,subject to        
subparagraph 7,b71 a ,veterans ,care    
,agreement is of material size as       
determined by the ,secretary for        
purposes of this section4  7,b7 ,a      
,veterans ,care ,agreement entered into 

after ,september #cj1 #bjah1 for the    
purchase of extended care services is of
 material size if the purchase of such  
services under the agreement exceeds    
#a1jjj1jjj annually4 ,the ,secretary may
 adjust such amount to account for      
changes in the cost of health care based
 upon recognized health care market     
surveys and other available data and    
shall publish any such adjustments in   
the ,federal ,register4  7g7 ,treatment 
of certain laws  7#a7 ,an agreement     
under this section may be entered into  
without regard to any law that would    
require the ,secretary to use           
competitive procedures in selecting the 
party with which to enter into the      
agreement4  7#b7  7,a7 ,except as       
provided in subparagraph 7,b7 and unless
 otherwise provided in this section or  
regulations prescribed pursuant to this 
section1 an eligible provider that      
enters into an agreement under this     
section is not subject to1 in the       
carrying out of the agreement1 any law  

that an eligible provider described in  
subsection 7b77#a71 7b77#b71 or 7b77#c7 
is not subject to under the original    
,medicare fee-for-service program under 
parts ,a and ,b of title ,,xviii of the 
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 or the ,medicaid program 
under title ,,xix of such ,act 7#db     
,u4,s4,c4 #acif et seq474  7,b7 ,the    
exclusion under subparagraph 7,a7 does  
not apply to laws regarding integrity1  
ethics1 fraud1 or that subject a person 
to civil or criminal penalties4  7#c7   
,title ,,vii of the ,civil ,rights ,act 
of #aifd 7#db ,u4,s4,c4 #bjjj;e et seq47
 shall apply with respect to an eligible
 provider that enters into an agreement 
under this section to the same extent as
 such title applies with respect to the 
eligible provider in providing care or  
services through an agreement or        
arrangement other than under this       
section4  7h7 ,monitoring of quality of 
care ,the ,secretary shall establish a  
system or systems1 consistent with      

survey and certification procedures used
 by the ,centers for ,medicare          
,medicaid ,services and ,state survey   
agencies to the extent practicable--    
7#a7 to monitor the quality of care and 
services furnished to veterans under    
this section2 and  7#b7 to assess the   
quality of care and services furnished  
by an eligible provider for purposes of 
determining whether to renew an         
agreement under this section with the   
eligible provider4  7i7 ,dispute        
resolution  7#a7 ,the ,secretary shall  
establish administrative procedures for 
eligible providers with which the       
,secretary has entered an agreement     
under this section to present any       
dispute arising under or related to the 
agreement4  7#b7 ,before using any      
dispute resolution mechanism under      
chapter #ga of title #da with respect to
 a dispute arising under an agreement   
under this section1 an eligible provider
 must first exhaust the administrative  
procedures established by the ,secretary

 under paragraph 7#a74  4  7b7          
,regulations ,the ,secretary of         
,veterans ,affairs shall prescribe an   
interim final rule to carry out section 
#agjc;,a of such title1 as added by     
subsection 7a71 not later than one year 
after the date of the enactment of this 
,act4  7c7 ,clerical amendment ,the     
table of sections at the beginning of   
chapter #ag of such title is amended by 
inserting after the item related to     
section #agjc the following new item3   
#agjc;,a4 ,veterans ,care ,agreements   
with certain health care providers4  4  
#d4 ,modification of authority to enter 
into agreements to provide nursing home 
care  7a7 ,use of agreements  7#a7 ,in  
general ,paragraph 7#a7 of section      
#agde7;a7 of title #ch1 ,united ,states 
,code1 is amended1 in the matter        
preceding subparagraph 7,a71 by striking
 a contract 7or agreement under section 
#agbj7;c77#a7 of this title7 and        
inserting an agreement4  7#b7 ,payment  
,paragraph 7#b7 of such section is      

amended by striking contract 7or        
agreement7 each place it appears and    
inserting agreement4  7b7 ,exclusion of 
certain ,federal contracting provisions 
,such section is amended by adding at   
the end the following new paragraph3    
7#d7  7,a7 ,an agreement under this     
section may be entered into without     
regard to any law that would require the
 ,secretary to use competitive          
procedures in selecting the party with  
which to enter into the agreement4  7,b7
  7i7 ,except as provided in clause 7ii7
 and unless otherwise provided in this  
section or regulations prescribed       
pursuant to this section1 a ,state home 
that enters into an agreement under this
 section is not subject to1 in the      
carrying out of the agreement1 any law  
that a provider described in            
subparagraph 7,d7 is not subject to     
under the original ,medicare            
fee-for-service program under parts ,a  
and ,b of title ,,xviii of the ,social  
,security ,act 7#db ,u4,s4,c4 #acie et  

seq47 or the ,medicaid program under    
title ,,xix of such ,act 7#db ,u4,s4,c4 
#acif et seq474  7ii7 ,the exclusion    
under clause 7i7 does not apply to laws 
regarding integrity1 ethics1 fraud1 or  
that subject a person to civil or       
criminal penalties4  7,c7 ,title ,,vii  
of the ,civil ,rights ,act of #aifd 7#db
 ,u4,s4,c4 #bjjj;e et seq47 shall apply 
with respect to any ,state home that    
enters into an agreement under this     
section4  7,d7 ,a provider described in 
this subparagraph is one of the         
following3 7i7 ,a provider of services  
that has enrolled and entered into a    
provider agreement under section        
#ahff7;a7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;cc7a774  7ii7 ,a   
physician or supplier that has enrolled 
and entered into a participation        
agreement under section #ahdb7;h7 of    
such ,act 7#db ,u4,s4,c4 #acieu7h774    
7iii7 ,a provider of items and services 
receiving payment under a ,state plan   
under title ,,xix of such ,act 7#db     

,u4,s4,c4 #acif et seq47 or a waiver of 
such a plan4  4  7c7 ,effective date    
,the amendments made by this section    
shall apply to agreements entered into  
under section #agde of such title on and
 after the date that is #cj days after  
the date of the enactment of this ,act4