,i  #aae? ,,congress  #a/ ,session  ,h4 
,r4 #dbdb  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,novemb] #c1 #bjag,mr4
 ,roe ( ,t5nessee 7= himself1 ,mr4      
,c(fman1 ,mr4 ,w5/rup1 ,mrs4 ,radewag51 
,mr4 ,bo/1 ,mr4 ,poliqu91 ,mr4 ,arr+ton1
 ,mr4 ,ru!r=d1 ,mr4 ,higg9s ( ,l\isiana1
 ,mr4 ,b]gman1 ,mr4 ,banks ( ,indiana1  
,miss ,gonzlez-,coln ( ,pu]to ,rico1    
,mr4 ,bilirakis1 ,mr4 ,dunn1 ,mr4 ,walz1
 ,ms4 ,ku/] ( ,new ,hamp%ire1 ,miss     
,rice ( ,new ,york1 ,mr4 ,correa1 ,mr4  
,sablan1 ,ms4 ,e/y ( ,connecticut1 ,mr4 
,pet]s1 ,mr4 ,o',r\rke1 ,mr4 ,takano1 & 
,ms4 ,br[nley ( ,cali=nia7 introduc$ !  
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,vet]ans' ,affairs  ,a    
,,bill  ,to am5d title #ch1 ,unit$      
,/ates ,code1 to e/abli% a p]man5t ,,va 
,c>e 9 ! ,community ,program1 & = o!r   
purposes4  #a4 ,%ort title2 table (     
cont5ts  7a7 ,%ort title ,?is ,act may  
be cit$ z ! ,,va ,c>e 9 ! ,community    
,act4  7b7 ,table ( cont5ts ,! table (  
cont5ts = ?is ,act is z foll[s3  ,sec4  

#a4 ,%ort title2 table ( cont5ts4 ,title
 ,i--,improv$ access = vet]ans to       
non-,dep>tm5t ( ,vet]ans ,affairs m$ical
 c>e ,sec4 #aja4 ,assignm5t ( vet]ans to
 prim>y c>e provid]s4 ,sec4 #ajb4       
,e/abli%m5t ( ,,va ,c>e 9 ! ,community  
,program4 ,sec4 #ajc4 ,vet]ans ,c>e     
,agreem5ts4 ,sec4 #ajd4 ,modification ( 
au?ority to ent] into agreem5ts ) ,/ate 
homes to provide nurs+ home c>e4 ,sec4  
#aje4 ,dep>tm5t ( ,vet]ans ,affairs     
electronic int]face = process+ ( m$ical 
claims4 ,sec4 #ajf4 ,fund+ = ,,va ,c>e 9
 ! ,community ,program4 ,sec4 #ajg4     
,t]m9ation ( c]ta9 provisions au?oriz+  
m$ical c>e to vet]ans ?r\gh             
non-,dep>tm5t ( ,vet]ans ,affairs       
provid]s4 ,sec4 #ajh4 ,implem5tation &  
transition4 ,title ,,ii--,o!r           
adm9i/rative matt]s ,sec4 #bja4         
,reimbursem5t = em]g5cy ambulance       
s]vices4 ,sec4 #bjb4 ,improvem5t ( c>e  
coord9ation = vet]ans ?r\gh ex*ange (   
c]ta9 m$ical records4 ,sec4 #bjc4       
,elim9ation ( copaym5t (fset4 ,sec4     

#bjd4 ,use ( ,dep>tm5t ( ,vet]ans       
,affairs ,m$ical ,c>e ,collections ,fund
 = c]ta9 improvem5ts 9 collections4     
,sec4 #bje4 ,dep>tm5t ( ,vet]ans        
,affairs heal? c>e productivity         
improvem5t4 ,sec4 #bjf4 ,lic5sure (     
heal? c>e pr(essionals ( ! ,dep>tm5t (  
,vet]ans ,affairs provid+ treatm5t via  
telem$ic9e4  ,i ,improv$ access =       
vet]ans to non-,dep>tm5t ( ,vet]ans     
,affairs m$ical c>e  #aja4 ,assignm5t ( 
vet]ans to prim>y c>e provid]s ,section 
#agjf ( title #ch1 ,unit$ ,/ates ,code1 
is am5d$ by add+ at ! end ! foll[+ new  
subsection3  7d7  7#a7 ,except z provid$
 9 section #agjc;,a ( ?is title1 9      
furni%+ prim>y c>e "u ?is *apt]1 !      
,secret>y %all assign ea* eligible      
vet]an to--  7,a7 a pati5t-align$ c>e   
team ( ! ,dep>tm5t2 or  7,b7 a d$icat$  
prim>y c>e provid] ( ! ,dep>tm5t z a "p 
( any o!r model ( provid+ consi/5t      
prim>y c>e det]m9$ appropriate by !     
,secret>y4  7#b7 ,ea* pati5t-align$ c>e 
team ( ! ,dep>tm5t %all consi/ ( a team 

( heal? c>e pr(essionals ( ! ,dep>tm5t  
:o--  7,a7 provide to ea* eligible      
vet]an compreh5sive prim>y c>e 9        
p>tn]%ip ) ! vet]an2 &  7,b7 manage &   
coord9ate compreh5sive hospital c>e &   
m$ical s]vices consi/5t ) ! goals ( c>e 
agre$ ^u by ! vet]an & team4  7#c7 ,!   
,secret>y %all ensure t an eligible     
vet]an is n simultane\sly assign$ to m  
?an "o pati5t-align$ c>e team or d$icat$
 prim>y c>e provid] "u ?is subsection at
 a s+le location1 includ+ by e/abli%+   
proc$ures 9 ! ev5t a prim>y c>e provid] 
retires or is o!rwise no long] able to  
treat ! vet]an4 ,9 ! case ( an eligible 
vet]an :o resides 9 m ?an "o location1 !
 ,secret>y may assign su* vet]an to a   
pati5t-align$ c>e team or d$icat$ prim>y
 c>e provid] at ea* su* location4  7#d7 
,! t]m eligible vet]an means a vet]an   
:o-- 7,a7 is enroll$ 9 ! pati5t         
enrollm5t sy/em ( ! ,dep>tm5t e/abli%$ &
 op]at$ "u section #agje7;a7 ( ?is      
title2 &  7,b7 has-- 7i7 be5 furni%$    
hospital c>e or m$ical s]vices at or    

?r\gh a ,dep>tm5t facility on at lea/ "o
 occasion dur+ ! two-ye> p]iod prec$+ ! 
date ( ! det]m9ation ( eligibility2 or  
7ii7 reque/$ a fir/-"t appo9tm5t =      
hospital c>e or m$ical s]vices at a     
,dep>tm5t facility4  4  #ajb4           
,e/abli%m5t ( ,,va ,c>e 9 ! ,community  
,program  7a7 ,e/abli%m5t ( program     
7#a7 ,9 g5]al ,*apt] #ag ( title #ch1   
,unit$ ,/ates ,code1 is am5d$ by ins]t+ 
aft] section #agjc ! foll[+ new section3
  #agjc;,a4 ,,va ,c>e 9 ! ,community    
,program  7a7 ,program  7#a7 ,subject to
 ! availability ( appropriations = su*  
purpose1 hospital c>e1 m$ical s]vices1 &
 ext5d$ c>e s]vices "u ?is *apt] %all be
 furni%$ to an eligible vet]an ?r\gh    
contracts or agreem5ts au?oriz$ "u      
subsection 7d71 or contracts or         
agreem5ts1 includ+ national contracts or
 agreem5ts1 au?oriz$ "u section #haec ( 
?is title or any o!r provision ( law    
adm9i/]$ by ! ,secret>y1 ) network      
provid]s = ! furni%+ ( su* c>e & s]vices
 to vet]ans4  7#b7 ,subject to          

subsection 7b71 an eligible vet]an may  
select a provid] ( su* c>e or s]vices f 
among network provid]s4  7#c7 ,!        
,secret>y %all coord9ate ! furni%+ ( c>e
 & s]vices "u ?is section to eligible   
vet]ans4  7#d7  7,a7 ,9 c>ry+ out ?is   
section1 ! ,secret>y %all e/abli%       
regional networks ( network provid]s4 ,!
 ,secret>y %all det]m9e1 & may modify1  
su* regions bas$ on ! capacity & m>ket  
assessm5ts ( ,vet]ans ,integrat$ ,s]vice
 ,networks conduct$ "u subsection 7k7 or
 ^u recogniz$ ne$4  7,b7 ,! ,secret>y   
may ent] into "o or m contracts = !     
purposes ( manag+ ! op]ations ( !       
regional networks & = ! deliv]y ( c>e   
pursuant to ?is section4  7b7 ,prim>y & 
specialty c>e  7#a7  7,a7 ,if !         
,secret>y is unable to assign an        
eligible vet]an to a pati5t-align$ c>e  
team or d$icat$ prim>y c>e provid] "u   
section #agjf7;d7 ( ?is title because ! 
,secret>y det]m9es su* a c>e team or    
provid] at a ,dep>tm5t facility is n    
available--  7i7 ! ,secret>y %all       

consult ) ! vet]an reg>d+ available     
prim>y c>e provid]s f among network     
provid]s t are locat$ 9 ! regional      
network 9 :i* ! vet]an resides or a     
regional network t is adjac5t to !      
regional network 9 :i* ! vet]an resides2
 &  7ii7 ! vet]an may select "o ( !     
available prim>y c>e provid]s to s]ve z 
! d$icat$ prim>y c>e provid] ( ! vet]an4
  7,b7 ,9 det]m9+ :e!r a pati5t-align$  
c>e team or d$icat$ provid] "u section  
#agjf7;d7 ( ?is title is available =    
assignm5t to a vet]an1 ! ,secret>y %all 
take into consid]ation ea* ( ! foll[+3  
7i7 ,:e!r ! vet]an faces an unusual or  
excessive burd5 9 access+ su*           
pati5t-align$ c>e team or d$icat$       
provid] at a m$ical facility ( !        
,dep>tm5t includ+ ) respect to--  7,i7  
geographical *all5ges2  7,,ii7          
environm5tal factors1 includ+ roads t   
are n accessible to ! g5]al public1     
traffic1 or haz>d\s wea!r2  7,,iii7 a   
m$ical condition ( ! vet]an2 or  7,,iv7 
su* o!r factors z det]m9$ by !          

,secret>y4  7ii7 ,:e!r ! vet]an         
reasonably believes t ! assignm5t ( a   
p>ticul> c>e team or provid] to ! vet]an
 w\ld detrim5tally affect !             
pati5t-provid] relation%ip & result 9   
sub-optimal c>e to ! vet]an4  7iii7     
,:e!r ! panel size ( ! c>e team or      
provid] is at su* a numb] t x w\ld      
result 9 difficulty = ! vet]an 9 access+
 timely c>e or 9 sub-optimal c>e to !   
vet]an4  7,c7 ,if ! ,secret>y det]m9es t
 a pati5t-align$ c>e team or d$icat$    
prim>y c>e provid] at a ,dep>tm5t       
facility has become available =         
assignm5t to an eligible vet]an :o _h   
be5 assign$ to a network provid] "u     
subp>agraph 7,a71 ! ,secret>y %all      
provide ! vet]an ) ! option (           
reassignm5t to ! team or provid] at !   
,dep>tm5t facility4  7,d7 ,9 ! case ( an
 eligible vet]an :o is assign$ to a     
network provid] "u subp>agraph 7,a71 !  
,secret>y %all reevaluate su* assignm5t 
n e>li] ?an "o ye> aft] a vet]an makes a
 selection "u subp>agraph 7,a77ii71 & on

 an annual basis !reaft]1 to--  7i7     
det]m9e :e!r ! ,secret>y is able to     
assign to ! vet]an a pati5t-align$ c>e  
team or d$icat$ prim>y c>e provid] "u   
section #agjf7;d7 ( ?is title2 &  7ii7 9
 consultation ) & ^u approval ( !       
vet]an1 make su* assignm5t if able4     
7#b7 7,a7 7i7 ,except z provid$ 9 clause
 7ii71 ! ,secret>y may only furni%      
specialty hospital c>e1 m$ical s]vices1 
or ext5d$ c>e s]vices to an eligible    
vet]an "u ?is section pursuant to a     
ref]ral = su* specialty c>e or s]vices  
made by ! prim>y c>e provid] ( ! vet]an4
  7ii7 ,! ,secret>y may designate       
specialties :i* %all be exempt f !      
requirem5t "u clause 7i74  7,b7 ,!      
,secret>y %all det]m9e :e!r to furni%   
specialty hospital c>e1 m$ical s]vices1 
or ext5d$ c>e s]vices to an eligible    
vet]an pursuant to subp>agraph 7,a7--   
7i7 at a m$ical facility ( ! ,dep>tm5t t
 is )9 a reasonable di/ance ( ! resid5ce
 ( ! vet]an1 z det]m9$ by ! ,secret>y2  
7ii7 by a network provid] t1 to !       

greate/ ext5t practicable1 is locat$ 9 !
 regional network 9 :i* ! vet]an resides
 or a regional network t is adjac5t to !
 regional network 9 :i* ! vet]an        
resides2 or  7iii7 pursuant to an       
agreem5t describ$ 9 subp>agraph 7,c74   
7,c7 ,an agreem5t describ$ 9 ?is        
subp>agraph is an agreem5t ent]$ into by
 ! ,secret>y ) a network provid] "u     
:i*--  7i7 specialty hospital c>e1      
m$ical s]vices1 or ext5d$ c>e s]vices   
are furni%$ to an eligible vet]an       
pursuant to subp>agraph 7,a7--  7,i7 at 
a m$ical facility ( ! ,dep>tm5t by a    
network provid] possess+ ! appropriate  
cr$5tials1 z det]m9$ by ! ,secret>y2 or 
7,,ii7 at a facility ( a network provid]
 by a heal? c>e provid] ( ! ,dep>tm5t2 &
  7ii7 su* specialty c>e or s]vices are 
s furni%$ ei!r--  7,i7 9 accordance )   
?is section ) respect to fees & paym5ts 
= c>e & s]vices furni%$ "u subsection   
7a72 or  7,,ii7 at no co/ to ! ,unit$   
,/ates4  7,d7 ,9 mak+ ! det]m9ation "u  
subp>agraph 7,b71 ! ,secret>y %all give 

priority to m$ical facilities & heal?   
c>e provid]s ( ! ,dep>tm5t b %all take  
into acc\nt--  7i7 :e!r ! vet]an faces  
an unusual or excessive burd5 9 access+ 
su* specialty hospital c>e1 m$ical      
s]vices1 or ext5d$ c>e s]vices at a     
m$ical facility ( ! ,dep>tm5t1 includ+ )
 respect to--  7,i7 geographical        
*all5ges2  7,,ii7 environm5tal factors1 
su* z roads t are n accessible to !     
g5]al public1 traffic1 or haz>d\s wea!r2
  7,,iii7 a m$ical condition ( ! vet]an2
 or  7,,iv7 su* o!r factors z det]m9$ by
 ! ,secret>y2 &  7ii7 :e!r ! prim>y c>e 
provid] ( ! vet]an recomm5ds t su*      
specialty hospital c>e1 m$ical s]vices1 
or ext5d$ c>e s]vices %\ld be furni%$ by
 a network provid]4  7,e7 ,! ,secret>y  
%all ensure t ea* m$ical facility ( !   
,dep>tm5t processes ref]rals = specialty
 hospital c>e1 m$ical s]vices1 or ext5d$
 c>e s]vices 9 a /&>diz$ mann]1 includ+ 
) respect to ! organization ( ! program 
(fice responsible = su* ref]rals4  7,f7 
,9 c>ry+ out ?is section1 ! ,secret>y   

%all e/abli% a process to review any    
disagreem5t betwe5 an eligible vet]an & 
! ,dep>tm5t1 or betwe5 an eligible      
vet]an & a heal? c>e provid] ( !        
,dep>tm5t1 reg>d+ ! eligibility ( !     
vet]an to receive c>e or s]vices f a    
network provid] "u ?is section or !     
assignm5t ( a prim>y c>e provid] ( !    
,dep>tm5t to ! vet]an4 ,9 review+ a     
disagreem5t "u su* process ) respect to 
! availability ( & assignm5t to a pati5t
 align$ c>e team or d$icat$ prim>y c>e  
provid]1 ! ,secret>y %all give def]5ce  
to ! vet]an ) respect to any det]m9ation
 "u subsection 7b77#a77;,b77ii74  7c7   
,episodes ( c>e  7#a7 ,! ,secret>y %all 
ensure t1 at ! election ( an eligible   
vet]an :o receives hospital c>e1 m$ical 
s]vices1 or ext5d$ c>e s]vices f a      
network provid] 9 an episode ( c>e "u   
?is section1 ! vet]an receives su* c>e  
or s]vices f t network provid]1 ano!r   
network provid] select$ by ! vet]an1 or 
a heal? c>e provid] ( ! ,dep>tm5t1 ?r\gh
 ! completion ( ! episode ( c>e1 includ+

 all specialty & ancill>y s]vices       
det]m9$ necess>y by ! provid] z "p ( !  
treatm5t recomm5d$ 9 ! c\rse ( su* c>e  
or s]vices4 ,9 mak+ su* det]m9ation )   
respect to necess>y specialty & ancill>y
 s]vices provid$ by a network provid]1 !
 network provid] %all consult ) !       
,secret>y1 act+ ?r\gh ! program (fice ( 
! appropriate m$ical facility4  7#b7 ,9 
cases ( episodes ( c>e t ! ,secret>y    
det]m9es case managem5t to be           
appropriate1 ! ,secret>y %all provide   
case managem5t to an eligible vet]an :o 
receives hospital c>e1 m$ical s]vices1  
or ext5d$ c>e s]vices f a network       
provid] = su* episodes ( c>e4 ,!        
,secret>y may provide su* case managem5t
 ?r\gh ! ,vet]ans ,heal? ,adm9i/ration  
or ?r\gh an entity t manages ! op]ations
 ( ! regional networks pursuant to      
subsection 7a77#d77;,b74  7d7 ,c>e &    
s]vices ?r\gh contracts & agreem5ts     
7#a7 ,! ,secret>y %all ent] into        
contracts or agreem5ts1 includ+ national
 contracts or agreem5ts =1 b n limit$   

to1 dialysis1 = furni%+ c>e & s]vices to
 eligible vet]ans "u ?is section )      
network provid]s4  7#b7  7,a7 ,9 ent]+  
into a contract or agreem5t "u p>agraph 
7#a7 ) a network provid]1 ! ,secret>y   
%all--  7i7 negotiate rates = ! furni%+ 
( c>e & s]vices "u ?is section2 &  7ii7 
reimburse ! provid] = su* c>e & s]vices 
at ! rates negotiat$ pursuant to clause 
7i7 z provid$ 9 su* contract or         
agreem5t4  7,b7  7i7 ,except z provid$ 9
 p>agraph 7#c71 rates negotiat$ "u      
subp>agraph 7,a77i7 %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$ic>e 
,program "u title ,,xviii ( ! ,social   
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 = ! same c>e or s]vices4  7ii7 ,9 
det]m9+ ! rates "u ! ,m$ic>e ,program "u
 title ,,xviii ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie et seq47 =    

purposes ( clause 7i71 9 ! case ( c>e or
 s]vices furni%$ by a provid] ( s]vices 
) respect to :i* su* rates are det]m9$  
"u a fee s*$ule to :i* ! area wage index
 "u section #ahhf7;d77#c77;,e7 ( !      
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7d77#c77;,e77 applies1 su* area  
wage index s appli$ to su* provid] (    
s]vices may n be less ?an #a4jj4  7,c7  
,9 c>ry+ out p>agraph 7#b71 ! ,secret>y 
may incorporate ! use ( value-bas$      
reimbursem5t models to promote !        
provision ( high-quality c>e4  7#c7     
7,a7 ,) respect to ! furni%+ ( c>e or   
s]vices "u ?is section to an eligible   
vet]an :o resides 9 a highly rural area 
7z def9$ "u ! rural-urban commut+ area  
codes develop$ by ! ,secret>y (         
,agriculture & ! ,secret>y ( ,heal? &   
,human ,s]vices71 ! ,secret>y ( ,vet]ans
 ,affairs may negotiate a rate t is m   
?an ! rate paid by ! ,unit$ ,/ates z    
describ$ 9 p>agraph 7#b77;,b74  7,b7 ,) 
respect to furni%+ c>e or s]vices "u ?is
 section 9 ,alaska1 ! ,alaska ,fee      

,s*$ule ( ! ,dep>tm5t ( ,vet]ans        
,affairs w be foll[$1 except = :5 ano!r 
paym5t agreem5t1 includ+ a contract or  
provid] agreem5t1 is 9 place4  7,c7 ,)  
respect to furni%+ c>e or s]vices "u ?is
 section 9 a ,/ate ) an ,all-,pay]      
,model ,agreem5t "u ! ,social ,security 
,act t became effective on or aft]      
,janu>y #a1 #bjad1 ! ,m$ic>e paym5t     
rates "u p>agraph 7#b77;,b7 %all be     
calculat$ bas$ on ! paym5t rates "u su* 
agreem5t1 or any su* successor agreem5t4
  7,d7 ,) respect to furni%+ c>e or     
s]vices "u ?is section 9 a location 9   
:i* ! ,secret>y det]m9es t adju/+ ! rate
 paid by ! ,unit$ ,/ates z describ$ 9   
p>agraph 7#b77;,b7 is appropriate1 !    
,secret>y may negotiate su* an adju/$   
rate4  7,e7 ,) respect to furni%+ c>e or
 s]vices "u ?is section 9 a location or 
9 a situation 9 :i* an exception to !   
rates paid by ! ,unit$ ,/ates "u !      
,m$ic>e ,program "u title ,,xviii ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#acie et seq47 = ! same c>e or s]vices  

applies1 ! ,secret>y may foll[ su*      
exception4  7,f7 ,) respect to furni%+  
c>e or s]vices "u ?is section = c>e or  
s]vices n cov]$ "u ! ,m$ic>e ,program "u
 title ,,xviii ( ! ,social ,security    
,act 7#db ,u4,s4,c4 #acie et seq471 !   
,secret>y %all e/abli% a s*$ule ( fees =
 su* c>e or s]vices4  7,g7 ,) respect to
 furni%+ c>e or s]vices "u ?is section  
pursuant to an agreem5t ) a tribal or   
,f$]al entity1 ! ,secret>y may negotiate
 a rate t is m ?an ! rate paid by !     
,unit$ ,/ates z describ$ 9 p>agraph     
7#b77;,b74  7#d7 ,= ! furni%+ ( c>e or  
s]vices pursuant to a contract or       
agreem5t "u p>agraph 7#a71 a network    
provid] may n collect any am\nt t is    
great] ?an ! rate negotiat$ pursuant to 
p>agraph 7#b77;,a74  7#e7  7,a7 ,if1 9 !
 c\rse ( an episode ( c>e "u ?is        
section1 any "p ( c>e or s]vices is     
furni%$ by a m$ical provid] :o is n a   
network provid]1 ! ,secret>y may        
comp5sate su* provid] = furni%+ su* c>e 
or s]vices4  7,b7 ,! ,secret>y %all make

 reasonable ef=ts to ent] into a        
contract or agreem5t "u ?is section )   
any provid] :o is comp5sat$ pursuant to 
subp>agraph 7,a74  7e7 ,prompt paym5t   
/&>d  7#a7 ,! ,secret>y %all ensure t   
claims = paym5ts = hospital c>e1 m$ical 
s]vices1 or ext5d$ c>e s]vices furni%$  
"u ?is section are process$ 9 accordance
 ) ?is subsection1 reg>dless ( :e!r su* 
claims are--  7,a7 made by a network    
provid] to ! ,secret>y2  7,b7 made by a 
network provid] to a regional network   
op]at$ by a contractor pursuant to      
subsection 7a77#d77;,b72 or  7,c7 made  
by su* a regional network to !          
,secret>y4  7#b7 ,a cov]$ claimant t    
seeks paym5t = hospital c>e1 m$ical     
s]vices1 or ext5d$ c>e s]vices furni%$  
"u ?is section %all submit to ! cov]$   
pay] a claim = paym5t n lat] ?an--  7,a7
 ) respect to a claim by a network      
provid]1 #ahj days aft] ! date on :i* ! 
network provid] furni%es su* c>e or     
s]vices2 or  7,b7 ) respect to a claim  
by a regional network op]at$ by a       

contractor1 #ahj days aft] ! date on :i*
 ! contractor pays ! network provid] =  
furni%+ su* c>e or s]vices4  7#c7       
,not)/&+ *apt] #ci ( title #ca or any   
o!r provision ( law1 ! cov]$ pay] %all  
pay a cov]$ claimant = hospital c>e1    
m$ical s]vices1 or ext5d$ c>e s]vices   
furni%$ "u ?is section--  7,a7 9 ! case 
( a clean claim submitt$ to ! cov]$ pay]
 on pap]1 n lat] ?an #de cal5d> days    
aft] receiv+ ! claim2 or  7,b7 9 ! case 
( a clean claim submitt$ to ! cov]$ pay]
 electronically1 n lat] ?an #cj cal5d>  
days aft] receiv+ ! claim4  7#d7  7,a7  
,if ! cov]$ pay] d5ies a claim submitt$ 
by a cov]$ claimant "u p>agraph 7#a71 ! 
cov]$ pay] %all notify ! cov]$ claimant 
( ! reason = d5y+ ! claim & ! additional
 in=mation1 if any1 t may be requir$ to 
process ! claim--  7i7 9 ! case ( a     
clean claim submitt$ to ! cov]$ pay] on 
pap]1 n lat] ?an #de cal5d> days aft]   
receiv+ ! claim2 or  7ii7 9 ! case ( a  
clean claim submitt$ to ! cov]$ pay]    
electronically1 n lat] ?an #cj cal5d>   

days aft] receiv+ ! claim4  7,b7 ,^u    
receipt by ! cov]$ pay] ( additional    
in=mation specifi$ "u subp>agraph 7,a7  
relat+ to a claim1 ! cov]$ pay] %all    
pay1 d5y1 or o!rwise adjudicate ! claim1
 z appropriate1 n lat] ?an #cj cal5d>   
days aft] receiv+ su* in=mation4  7#e7  
7,a7 ,if ! cov]$ pay] has n paid a cov]$
 claimant or d5i$ a clean claim = paym5t
 by ! cov]$ claimant "u ?is subsection  
dur+ ! appropriate p]iod specifi$ 9 ?is 
subsection1 su* clean claim %all be     
consid]$ ov]due4  7,b7 ,if a clean claim
 = paym5t by a cov]$ claimant is        
consid]$ ov]due "u subp>agraph 7,a71 9  
addition to ! am\nt ! cov]$ pay] owes ! 
cov]$ claimant "u ! claim1 ! cov]$ pay] 
%all owe ! cov]$ claimant 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 ! cov]$ pay]  
accrues ! obligation to pay ! int]e/    
p5alty am\nt4  7#f7  7,a7 ,if ! cov]$   
pay] ov]pays a cov]$ claimant = hospital
 c>e1 m$ical s]vices1 or ext5d$ c>e     
s]vices furni%$ "u ?is section--  7i7 ! 
cov]$ pay] %all d$uct ! am\nt ( any     
ov]paym5t f paym5ts due to ! cov]$      
claimant aft] ! date ( su* ov]paym5t2 or
  7ii7 if ! cov]$ pay] det]m9es t !re   
are no su* paym5ts due aft] ! date ( !  
ov]paym5t1 ! cov]$ claimant %all refund 
! am\nt ( su* ov]paym5t n lat] ?an #cj  
days aft] su* det]m9ation4  7,b7  7i7   
,be=e d$uct+ any am\nt f a paym5t to a  
cov]$ claimant "u subp>agraph 7,a71 !   
cov]$ pay] %all ensure t ! cov]$        
claimant is provid$ an opportunity--    
7,i7 to dispute ! exi/5ce or am\nt ( any
 ov]paym5t ow$ to ! cov]$ pay]2 &       
7,,ii7 to reque/ a compromise ) respect 
to any su* ov]paym5t4  7ii7 ,! cov]$    
pay] may n make any d$uction f a paym5t 
to a cov]$ claimant "u subp>agraph 7,a7 

unless ! cov]$ pay] has made reasonable 
ef=ts to notify ! cov]$ claimant ( !    
rights ( ! cov]$ claimant "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 ! cov]$ pay] %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 ( ! cov]$ pay] to   
recov] ! full am\nt ow$ to ! cov]$ pay]4
  7#g7 ,not)/&+ any o!r provision ( law1
 ! ,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#h7 ,?is subsection %all 
apply only to paym5ts made on a claims  
basis & n to capitation or o!r =ms (    
p]iodic paym5ts to network provid]s4    
7#i7 ,a network provid] t provides      
hospital c>e1 m$ical s]vices1 or ext5d$ 
c>e s]vices to an eligible vet]an "u ?is

 section may n seek any paym5t = su* c>e
 or s]vices f ! eligible vet]an4  7#aj7 
,) respect to mak+ a paym5t = hospital  
c>e or m$ical s]vices furni%$ to an     
eligible vet]an by a network provid] "u 
?is section--  7,a7 ! ,secret>y may n   
require receipt by ! vet]an or !        
,dep>tm5t ( a m$ical record "u          
subsection 7g7 detail+ su* c>e or       
s]vices be=e a cov]$ pay] makes a paym5t
 = su* c>e or s]vices2 &  7,b7 !        
,secret>y may require t ! network       
provid] atte/s to su* c>e or s]vices s  
provid$ be=e a cov]$ pay] makes a paym5t
 = su* c>e or s]vices4  7f7 ,co/-,%>+   
7#a7 ,! ,secret>y %all require an       
eligible vet]an to pay a copaym5t = !   
receipt ( c>e or 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 at a m$ical facility 
( ! ,dep>tm5t or f a heal? c>e provid] (
 ! ,dep>tm5t "u ?is *apt]4  7#b7 ,!     
am\nt ( a copaym5t *>g$ "u p>agraph 7#a7
 may n exce$ ! am\nt ( ! copaym5t t w\ld

 be payable by su* eligible vet]an = !  
receipt ( su* c>e or s]vices at a m$ical
 facility ( ! ,dep>tm5t or f a heal? c>e
 provid] ( ! ,dep>tm5t "u ?is *apt]4    
7#c7 ,9 any case 9 :i* an eligible      
vet]an is furni%$ hospital c>e or m$ical
 s]vices "u ?is section = a             
non-s]vice-connect$ disability describ$ 
9 subsection 7a77#b7 ( section #agbi (  
?is title1 ! ,secret>y %all recov] or   
collect reasonable *>ges = su* c>e or   
s]vices f a heal?-plan contract describ$
 9 section #agje;,a 9 accordance ) su*  
section #agbi4  7g7 ,m$ical records     
7#a7 ,! ,secret>y %all ensure t any     
network provid] t furni%es c>e or       
s]vices "u ?is section to an eligible   
vet]an--  7,a7 ^u ! reque/ ( ! vet]an1  
provides to ! vet]an ! m$ical records   
relat$ to su* c>e or s]vices2 &  7,b7 ^u
 ! completion ( ! provision ( su* c>e or
 s]vices to su* vet]an1 provides to !   
,dep>tm5t ! m$ical records = ! vet]an   
furni%$ c>e or s]vices "u ?is section 9 
a timeframe & =mat specifi$ by !        

,secret>y = purposes ( ?is section1     
except ! ,secret>y may n require t any  
paym5t by ! ,secret>y to ! eligible     
provid] be cont+5t on su* provision (   
m$ical records4  7#b7 ,to ! ext5t       
practicable1 ! ,secret>y %all submit to 
a network provid] t furni%es c>e or     
s]vices "u ?is section to an eligible   
vet]an ! m$ical records ( su* eligible  
vet]an t are ma9ta9$ by ! ,dep>tm5t &   
are relevant to su* c>e or s]vices4     
7#c7 ,to ! ext5t practicable1 !         
,secret>y %all-- 7,a7 ensure t ! m$ical 
records %>$ "u p>agraphs 7#a7 & 7#b7 are
 %>$ 9 an electronic =mat accessible by 
network provid]s & ! ,dep>tm5t ?r\gh an 
,int]net website2 &  7,b7 provide to    
network provid]s access to ! electronic 
pati5t heal? record sy/em ( ! ,dep>tm5t1
 or successor sy/em1 = ! purpose (      
furni%+ c>e or s]vices "u ?is section4  
7h7 ,use ( c>d ,! ,secret>y %all ensure 
t ! vet]an heal? id5tification c>d1 or  
su* successor id5tification c>d1        
includes suffici5t in=mation to act z an

 id5tification c>d = an eligible entity 
or o!r non-,dep>tm5t facility4 ,!       
,secret>y may n use any am\nts made     
available to ! ,secret>y to issue       
sep>ate id5tification c>ds solely = !   
purpose ( c>ry+ out ?is section4  7i7   
,prescription m$ications  7#a7 ,)       
respect to requirem5ts relat+ to !      
lic5s+ or cr$5tial+ ( a network provid]1
 ! ,secret>y %all ensure t ! network    
provid] is able to submit prescriptions 
= ph>maceutical ag5ts on ! =mul>y ( !   
,dep>tm5t to ph>macies ( ! ,dep>tm5t 9 a
 mann] t is sub/antially simil> to !    
mann] 9 :i* ! network provid] submits   
prescriptions to retail ph>macies4  7#b7
 ,no?+ 9 ?is section %all be con/ru$ to 
affect ! process ( ! ,dep>tm5t = fill+ &
 pay+ = prescription m$ications4  7j7   
,quality ( c>e ,9 c>ry+ out ?is section1
 ! ,secret>y %all use ! quality ( c>e   
/&>ds set =? or us$ by ! ,c5t]s =       
,m$ic>e  ,m$icaid ,s]vices or o!r       
quality ( c>e /&>ds1 z det]m9$ by !     
,secret>y4  7k7 ,capacity & comm]cial   

m>ket assessm5ts  7#a7 ,on a p]iodic    
basis1 b n less (t5 ?an once e ?ree     
ye>s1 ! ,secret>y %all conduct an       
assessm5t ( ! capacity ( ea* ,vet]ans   
,integrat$ ,s]vice ,network & m$ical    
facility ( ! ,dep>tm5t to furni% c>e or 
s]vices "u ?is *apt]4 ,ea* su* assessm5t
 %all--  7,a7 id5tify gaps 9 furni%+ su*
 c>e or s]vices at su* ,vet]ans         
,integrat$ ,s]vice ,network or m$ical   
facility2  7,b7 id5tify h[ su* gaps c be
 fill$ by-- 7i7 ent]+ into contracts or 
agreem5ts ) network provid]s "u ?is     
section or ) entities "u o!r provisions 
( law2  7ii7 mak+ *anges 9 ! way su* c>e
 & s]vices are furni%$ at su* ,vet]ans  
,integrat$ ,s]vice ,network or m$ical   
facility1 includ+ b n limit$ to--  7,i7 
ext5d+ h\rs ( op]ation2  7,,ii7 add+    
p]sonnel2 or  7,,iii7 exp&+ space ?r\gh 
con/ruction1 leas+1 or %>+ ( heal? c>e  
facilities2 &  7iii7 ! build+ or        
realignm5t ( ,dep>tm5t res\rces or      
p]sonnel2  7,c7 =eca/1 bas$ on future   
projections & hi/orical tr5ds1 bo? !    

%ort- & long-t]m dem& 9 furni%+ c>e or  
s]vices at su* ,vet]ans ,integrat$      
,s]vice ,network or m$ical facility &   
assess h[ su* dem& affects ! ne$s to use
 su* network provid]s2  7,d7 include a  
comm]cial heal? c>e m>ket assessm5t (   
designat$ cat*m5t areas 9 ! ,unit$      
,/ates conduct$ by a nongov]nm5tal      
entity2 &  7,e7 consid] ! unique ability
 ( ! ,f$]al ,gov]nm5t to reta9 a pres5ce
 9 an area o!rwise devoid ( comm]cial   
heal? c>e provid]s or f :i* su* provid]s
 are at a risk ( leav+4  7#b7 ,!        
,secret>y %all submit ea* assessm5t "u  
p>agraph 7#a7 to ! ,committees on       
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives & ! ,s5ate & %all make  
ea* su* assessm5t publicly available4   
7l7 ,allocation ( funds ,! ,secret>y    
%all develop a plan = ! allocation (    
funds 9 ! ,m$ical ,community ,c>e       
acc\nt4  7m7 ,reports on rates ,n lat]  
?an ,decemb] #ca1 #bjai1 & annually     
!reaft] dur+ ea* ( ! subsequ5t ?ree     
ye>s1 ! ,secret>y %all submit to !      

,committees on ,vet]ans' ,affairs ( !   
,h\se ( ,repres5tatives & ! ,s5ate a    
report detail+1 = ! fiscal ye> prec$+ ! 
fiscal ye> dur+ :i* ! report is         
submitt$1 ! rates paid by ! ,secret>y = 
hospital c>e1 m$ical s]vices1 or ext5d$ 
c>e s]vices "u ?is section t1 pursuant  
to subsection 7d77#c71 are m ?an ! rates
 describ$ 9 subsection 7d77#b77;,b7 = ! 
same c>e or s]vices4  7n7 ,def9itions ,9
 ?is section3 7#a7 ,! t]m clean claim   
means a claim submitt$--  7,a7 to !     
cov]$ pay] by a cov]$ claimant =        
purposes ( paym5t by ! cov]$ pay] (     
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 ! network
 provid]2 &  7,c7 9 su* a nationally    
recogniz$ =mat z may be prescrib$ by !  
,secret>y = purposes ( pay+ claims =    
hospital c>e or m$ical s]vices furni%$  
"u ?is section4  7#b7 ,! t]m cov]$      
claimant means-- 7,a7 a network provid] 

t submits a claim to ! ,secret>y =      
purposes ( paym5t by ! ,secret>y (      
exp5ses = hospital c>e or m$ical s]vices
 furni%$ "u ?is section2 or  7,b7 a     
regional network op]at$ by a contractor 
pursuant to subsection 7a77#d77;,b7 t   
submits a claim to ! ,secret>y =        
purposes ( reimbursem5t = a paym5t made 
by ! contractor to a network provid] =  
hospital c>e or m$ical s]vices furni%$  
"u ?is section4  7#c7 ,! t]m cov]$ pay] 
means-- 7,a7 a regional network op]at$  
by a contractor pursuant to subsection  
7a77#d77;,b7 ) respect to a claim made  
by a network provid] to ! contractor =  
purposes ( paym5t by ! contractor (     
exp5ses = hospital c>e or m$ical s]vices
 furni%$ "u ?is section2 or  7,b7 !     
,secret>y ) respect to-- 7i7 a claim    
made by a network provid] to ! ,secret>y
 = purposes ( paym5t by ! ,secret>y (   
exp5ses = hospital c>e or m$ical s]vices
 furni%$ "u ?is section2 &  7ii7 a claim
 made by a regional network op]at$ by a 
contractor pursuant to subsection       

7a77#d77;,b7 = purposes ( reimbursem5t =
 a paym5t describ$ by subp>agraph 7,a74 
7#d7 ,! t]m eligible vet]an means a     
vet]an :o-- 7,a7 is enroll$ 9 ! pati5t  
enrollm5t sy/em ( ! ,dep>tm5t e/abli%$ &
 op]at$ "u section #agje7;a7 ( ?is      
title2 &  7,b7 has-- 7i7 be5 furni%$    
hospital c>e or m$ical s]vices at or    
?r\gh a ,dep>tm5t facility on at lea/ "o
 occasion dur+ ! two-ye> p]iod prec$+ ! 
date ( ! det]m9ation ( eligibility2 or  
7ii7 reque/$ a fir/-"t appo9tm5t =      
hospital c>e or m$ical s]vices at a     
,dep>tm5t facility4  7#e7 ,! t]m        
fraudul5t claim means a claim by a      
network provid] = reimbursem5t "u ?is   
section t includes an int5tional &      
delib]ate misrepres5tation ( a mat]ial  
fact or facts t is int5d$ to induce !   
,secret>y to pay an am\nt t 0 n legally 
ow$ to ! provid]4  4  7#b7 ,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 ,,va

 ,c>e 9 ! ,community ,program4  4  7b7  
,con=m+ am5dm5ts ,! ,vet]ans ,access1   
,*oice1 & ,acc\ntability ,act ( #bjad   
7,public ,law #aac-adf7 is am5d$-- 7#a7 
9 section #aja7p77#a7 7#ch ,u4,s4,c4    
#agja note71 by ins]t+ be=e ! p]iod at !
 end ! foll[+3 or ! date on :i* !       
,secret>y c]tifies to ! ,committees on  
,vet]ans' ,affairs ( ! ,h\se (          
,repres5tatives & ! ,s5ate t ! ,secret>y
 is fully implem5t+ section #agjc;,a (  
title #ch1 ,unit$ ,/ates ,code1 :i*ev]  
occurs fir/2 &  7#b7 9 section #bjh7a71 
by /rik+ section #aja & ins]t+ section  
#agjc;,a ( title #ch1 ,unit$ ,/ates     
,code4  7c7 ,def9itions ,section #agja (
 title #ch1 ,unit$ ,/ates ,code1 is     
am5d$ by add+ at ! end ! foll[+ new     
p>agraphs3  7#aa7 ,! t]m network provid]
 means any ( ! foll[+ heal? c>e provid]s
 t h ent]$ into a contract or agreem5t  
"u :i* ! provid] agrees to furni% c>e & 
s]vices to eligible vet]ans "u section  
#agjc;,a ( ?is title3  7,a7 ,any heal?  
c>e provid] or suppli] t is p>ticipat+ 9

 ! ,m$ic>e ,program "u title ,,xviii ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#acie et seq471 includ+ any physician   
furni%+ s]vices "u su* program4  7,b7   
,any provid] ( items & s]vices receiv+  
paym5t "u a ,/ate plan "u title ,,xix ( 
su* ,act 7#db ,u4,s4,c4 #acif et seq47  
or a waiv] ( su* a plan4  7,c7 ,any     
,f$]ally-qualifi$ heal? c5t] 7z def9$ 9 
section #aije7l77#b77;,b7 ( ! ,social   
,security ,act 7#db ,u4,s4,c4           
#acif;d7l77#b77;,b7774  7,d7 ,!         
,dep>tm5t ( ,def5se4  7,e7 ,! ,indian   
,heal? ,s]vice4  7,f7 ,any heal? c>e    
provid] t is an academic affiliate ( !  
,dep>tm5t4  7,g7 ,any heal? c>e provid] 
n o!rwise cov]$ "u any ( subp>agraphs   
7,a7 ?r\gh 7,f7 t meets crit]ia e/abli%$
 by ! ,secret>y = purposes ( su*        
section4  7#ab7 ,! t]m ,,va ,c>e 9 !    
,community ,program means ! program "u  
:i* ! ,secret>y furni%es hospital c>e or
 m$ical s]vices to vet]ans ?r\gh network
 provid]s pursuant to section #agjc;,a (
 ?is title4  4  7d7 ,transition (       

provision ( c>e ,?is ,act1 & ! am5dm5ts 
made by ?is ,act1 may n be con/ru$ to   
affect ! obligations ( ! ,secret>y (    
,vet]ans ,affairs "u contracts &        
agreem5ts = ! provision ( hospital c>e1 
m$ical s]vices1 & ext5d$ c>e s]vices    
ent]$ into be=e ! date ( ! enactm5t (   
?is ,act at ! t]ms & rates conta9$ 9 su*
 contracts & agreem5ts4  #ajc4 ,vet]ans 
,c>e ,agreem5ts  7a7 ,9 g5]al ,sub*apt] 
,i ( *apt] #ag ( title #ch1 ,unit$      
,/ates ,code1 is fur!r am5d$ by ins]t+  
aft] section #agjc;,a1 z add$ by section
 #ajb1 ! foll[+ new section3  #agjc;,b4 
,vet]ans ,c>e ,agreem5ts ) non-network  
provid]s  7a7 ,vet]ans ,c>e ,agreem5ts  
7#a7 ,9 addition to furni%+ hospital    
c>e1 m$ical s]vices1 or ext5d$ c>e      
s]vices "u ?is *apt] at facilities ( !  
,dep>tm5t or "u contracts or agreem5ts  
ent]$ into pursuant to section #agjc;,a 
( ?is title or any o!r provision ( law  
o!r ?an ?is section1 ! ,secret>y may    
furni% su* c>e & s]vices to eligible    
vet]ans ?r\gh ! use ( agreem5ts1 to be  

kn[n z ,vet]ans ,c>e ,agreem5ts1 ent]$  
into "u ?is section by ! ,secret>y )    
eligible non-network provid]s4  7#b7 ,! 
,secret>y may ent] into a ,vet]ans ,c>e 
,agreem5t "u ?is section ) an eligible  
non-network provid] if ! ,secret>y      
det]m9es t--  7,a7 ! provision ( !      
hospital c>e1 m$ical s]vices1 or ext5d$ 
c>e s]vices at a ,dep>tm5t facility is  
impracticable or inadvisable because ( !
 m$ical condition ( ! vet]an1 ! travel  
involv$1 or ! nature ( ! c>e or s]vices 
requir$1 or a comb9ation ( su* factors2 
&  7,b7 su* c>e or s]vices are n        
available to be furni%$ by a            
non-,dep>tm5t heal? c>e provid] "u a    
contract or agreem5t ent]$ into pursuant
 to a provision ( law o!r ?an ?is       
section4  7#c7  7,a7 ,9 accordance )    
subp>agraphs 7,c7 & 7,d71 ! ,secret>y   
%all review ea* ,vet]ans ,c>e ,agreem5t 
) a non-network provid] to det]m9e :e!r 
x is practical or advisable to1 in/ead (
 c>ry+ out su* agreem5t--  7i7 provide  
at a ,dep>tm5t facility ! hospital c>e1 

m$ical s]vices1 or ext5d$ c>e s]vices   
cov]$ by su* agreem5t2 or  7ii7 ent]    
into an agreem5t ) ! provid] "u section 
#agjc;,a ( ?is title to provide su* c>e 
or s]vices4  7,b7 ,if ! ,secret>y       
det]m9es pursuant to a review ( a       
,vet]ans ,c>e ,agreem5t "u subp>agraph  
7,a7 t x is practical or advisable to   
provide hospital c>e1 m$ical s]vices1 or
 ext5d$ c>e s]vices at a ,dep>tm5t      
facility1 or ent] into an agreem5t "u   
section #agjc;,a ( ?is title to provide 
su* c>e or s]vices1 z ! case may be1 !  
,secret>y--  7i7 may n r5ew ! ,vet]ans  
,c>e ,agreem5t2 &  7ii7 %all take su*   
actions z are necess>y to implem5t su*  
det]m9ation4  7,c7 ,?is p>agraph %all   
apply ) respect to ,vet]ans ,c>e        
,agreem5ts ent]$ into ) a non-network   
provid] ^: gross annual rev5ue1 z       
det]m9$ "u subsection 7b77#a71 exce$s-- 
7i7 #c1jjj1jjj1 9 ! case ( a provid] t  
furni%es homemak] or home heal? aide    
s]vices2 or  7ii7 #a1jjj1jjj1 9 ! case (
 any o!r provid]4  7,d7 ,! ,secret>y    

%all conduct ea* review ( a ,vet]ans    
,c>e ,agreem5t "u subp>agraph 7,a7 z    
foll[s3  7i7 ,once dur+ ! #ah-mon? p]iod
 beg9n+ on ! date t is six mon?s aft]   
date on :i* ! agreem5t is ent]$ into4   
7ii7 ,n less ?an once dur+ ea* f\r-ye>  
p]iod beg9n+ on ! date on :i* ! review  
"u subp>agraph 7,a7 is conduct$4  7b7   
,eligible non-,network provid]s ,a      
provid] ( hospital c>e1 m$ical s]vices1 
or ext5d$ c>e s]vices is eligible to    
ent] into a ,vet]ans ,c>e ,agreem5t "u  
?is section if ! ,secret>y det]m9es t ! 
provid] meets ! foll[+ crit]ia3  7#a7 ,!
 gross annual rev5ue ( ! provid] "u     
contracts or agreem5ts ent]$ into ) !   
,secret>y 9 ! ye> prec$+ ! ye> 9 :i* !  
provid] ent]s into ! ,vet]ans ,c>e      
,agreem5t does n exce$--  7,a7          
#e1jjj1jjj 7z adju/$ 9 a mann] simil> to
 am\nts adju/$ pursuant to section #ecab
 ( ?is title71 9 ! case ( a provid] t   
furni%es homemak] or home heal? aide    
s]vices2 or  7,b7 #b1jjj1jjj 7z s       
adju/$71 9 ! case ( any o!r provid]4    

7#b7 ,! provid] is n a network provid] &
 does n o!rwise provide hospital c>e1   
m$ical s]vices1 or ext5d$ c>e s]vices to
 pati5ts pursuant to a contract ent]$   
into ) ! ,dep>tm5t4  7#c7 ,! provid]    
is-- 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;cc7a772  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     
#acieu7h772  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 plan2
  7,d7 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,e7 a c5t] = indep5d5t    
liv+ 7z def9$ 9 section #gjb ( !        
,rehabilitation ,act ( #aigc 7#bi       
,u4,s4,c4 #gif;a774  7#d7 ,! provid] is 

c]tifi$ pursuant to ! process e/abli%$  
"u subsection 7c77#a74  7#e7 ,any       
additional crit]ia det]m9$ appropriate  
by ! ,secret>y4  7c7 ,provid]           
c]tification  7#a7 ,! ,secret>y %all    
e/abli% a process = ! c]tification (    
eligible provid]s to ent] into ,vet]ans 
,c>e ,agreem5ts "u ?is section t %all1  
at a m9imum1 set =? ! foll[+3  7,a7     
,proc$ures = ! submission ( applications
 = c]tification & deadl9es = actions    
tak5 by ! ,secret>y ) respect to su*    
applications4  7,b7 ,/&>ds & proc$ures =
 ! approval & d5ial ( c]tifications & ! 
revocation ( c]tifications4  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   
#acie7;j77#b77;,b77 & ! /&>ds set =? "u 
section #i4ajd ( title #dh1 ,code (     
,f$]al ,regulations1 or any successor   
regulation4  7,d7 ,requirem5t = d5ial or
 revocation ( c]tification if !         

,secret>y det]m9es t ! o!rwise 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/em4     
7,e7 ,proc$ures by :i* a provid] ^:     
c]tification is d5i$ or revok$ "u !     
proc$ures e/abli%$ "u ?is subsection w  
be id5tifi$ z an exclud$ s\rce on ! li/ 
ma9ta9$ 9 ! ,sy/em = ,aw>d ,managem5t1  
or successor sy/em1 if ! ,secret>y      
det]m9es t su* exclusion is appropriate4
  7#b7 ,to ! ext5t practicable1 !       
,secret>y %all e/abli% ! proc$ures "u   
p>agraph 7#a7 9 a mann] t takes into    
acc\nt any c]tification process adm9i/]$
 by ano!r dep>tm5t or ag5cy ( ! ,f$]al  
,gov]nm5t t an eligible provid] has     
complet$ by reason ( be+ a provid]      

describ$ 9 any ( subp>agraphs 7,a7 ?r\gh
 7,e7 ( subsection 7b77#d74  7d7 ,t]ms (
 ,agreem5ts ,subsections 7d71 7e71 7f71 
& 7g7 ( section #agjc;,a ( ?is title    
%all apply ) respect to a ,vet]ans ,c>e 
,agreem5t 9 ! same mann] su* subsections
 apply to contracts & agreem5ts ent]$   
into "u su* section4  7e7 ,exclusion (  
c]ta9 ,f$]al contract+ provisions  7#a7 
,not)/&+ any o!r provision ( law1 !     
,secret>y may ent] into a ,vet]ans ,c>e 
,agreem5t us+ proc$ures o!r ?an         
competitive proc$ures4  7#b7  7,a7      
,except z provid$ 9 subp>agraph 7,b7 &  
unless o!rwise provid$ 9 ?is section1 an
 eligible non-network provid] t ent]s   
into a ,vet]ans ,c>e ,agreem5t "u ?is   
section is n subject to1 9 ! c>ry+ out (
 ! agreem5t1 any provision ( law t      
provid]s ( s]vices & suppli]s "u !      
orig9al ,m$ic>e fee-=-s]vice program "u 
p>ts ,a & ,b ( title ,,xviii ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acie et 
seq47 or ! ,m$icaid program "u title    
,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et

 seq47 are n subject to4  7,b7 ,9       
addition to ! provisions ( laws cov]$ by
 subp>agraph 7,a71 an eligible          
non-network provid] %all be subject to !
 foll[+ provisions ( law3  7i7 ,any     
applicable law reg>d+ integrity1 e?ics1 
or fraud1 or t subject a p]son to civil 
or crim9al p5alties4  7ii7 ,section     
#aceb ( title #ca1 except = ! fil+      
requirem5ts "u subsection 7b7 ( su*     
section4  7iii7 ,section #dgje or #dgab 
( title #da1 & any o!r applicable law   
reg>d+ ! protection ( :i/lebl[]s4  7iv7 
,section #dgjf7;d7 ( title #da4  7v7    
,title ,,vii ( ! ,civil ,rights ,act (  
#aifd 7#db ,u4,s4,c4 #bjjj;e et seq47 to
 ! same ext5t z su* title applies )     
respect to ! eligible non-network       
provid] 9 provid+ c>e or s]vices ?r\gh  
an agreem5t or arrangem5t o!r ?an "u a  
,vet]ans ,c>e ,agreem5t4  7f7 ,t]m9ation
 ( a ,vet]ans ,c>e agreem5t  7#a7 ,an   
eligible non-network provid] may t]m9ate
 a ,vet]ans ,c>e ,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 a ,vet]ans ,c>e
 ,agreem5t ) an eligible non-network    
provid] "u ?is section at su* "t & ^u   
su* notice to ! provid] z ! ,secret>y   
may specify = ! purposes ( ?is section1 
if ! ,secret>y det]m9es necess>y4  7g7  
,disputes  7#a7 ,! ,secret>y %all       
e/abli% adm9i/rative proc$ures =        
provid]s ) :i* ! ,secret>y has ent]$    
into a ,vet]ans ,c>e ,agreem5t 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 a  
,vet]ans ,c>e ,agreem5t "u ?is section1 
a provid] mu/ fir/ exhau/ ! adm9i/rative
 proc$ures e/abli%$ by ! ,secret>y "u   
p>agraph 7#a74  7h7 ,au?ority ,to pay = 
o!r au?oriz$ s]vices  7#a7 ,if1 9 !     
c\rse ( an episode ( c>e = :i* hospital 
c>e1 m$ical s]vices1 or ext5d$ c>e      
s]vices are furni%$ to an eligible      
vet]an pursuant to a ,vet]ans ,c>e      

,agreem5t1 any "p ( su* c>e or s]vices  
is furni%$ by a m$ical provid] :o is n  
an eligible non-network provid] or a    
network provid]1 ! ,secret>y may        
comp5sate su* provid] = furni%+ su* c>e 
or s]vices4  7#b7 ,! ,secret>y %all make
 reasonable ef=ts to ent] into a        
,vet]ans ,c>e ,agreem5t ) any provid] :o
 is comp5sat$ pursuant to p>agraph 7#a74
  7i7 ,annual reports  7#a7 ,n lat] ?an 
,decemb] #ca ( ! ye> foll[+ ! fiscal ye>
 9 :i* ! ,secret>y fir/ ent]s into a    
,vet]ans ,c>e ,agreem5t "u ?is section1 
& ea* ye> !reaft]1 ! ,secret>y %all     
submit to ! appropriate congressional   
committees an annual report t includes a
 li/ ( all ,vet]ans ,c>e ,agreem5ts     
ent]$ into z ( ! date ( ! report4  7#b7 
,! requirem5t to submit a report "u     
p>agraph 7#a7 %all t]m9ate on ! date t  
is five ye>s aft] ! date ( ! enactm5t ( 
?is section4  7j7 ,quality ( c>e ,9     
c>ry+ out ?is section1 ! ,secret>y %all 
use ! quality ( c>e /&>ds set =? or us$ 
by ! ,c5t]s = ,m$ic>e  ,m$icaid ,s]vices

 or o!r quality ( c>e /&>ds1 z det]m9$  
by ! ,secret>y4  7k7 ,delegation ,!     
,secret>y may delegate ! au?ority to    
ent] into or t]m9ate a ,vet]ans ,c>e    
,agreem5t to an (ficial ( ! ,dep>tm5t at
 a level n bel[ ! ,director ( a ,vet]ans
 ,integrat$ ,s]vice ,network or !       
,director ( a ,network ,contract+       
,(fice4  7l7 ,def9itions ,9 ?is section3
 7#a7 ,! t]m appropriate congressional  
committees means--  7,a7 ! ,committees  
on ,vet]ans' ,affairs ( ! ,h\se (       
,repres5tatives & ! ,s5ate2 &  7,b7 !   
,committees on ,appropriations ( ! ,h\se
 ( ,repres5tatives & ! ,s5ate4  7#b7 ,! 
t]m eligible vet]an has ! mean+ giv5 su*
 t]m 9 section #agjc;,a7m7 ( ?is title4 
4  7b7 ,cl]ical am5dm5t ,! table (      
sections at ! beg9n+ ( su* *apt] is     
am5d$ by ins]t+ aft] ! item relat+ to   
section #agjc;,a1 z add$ by section     
#ajb1 ! foll[+ new item3  #agjc;,b4     
,vet]ans ,c>e ,agreem5ts ) non-network  
provid]s4  4  #ajd4 ,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        
,treatm5t ( c]ta9 laws ,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 are n subject "u !   
orig9al ,m$ic>e fee-=-s]vice program "u 
p>ts ,a & ,b ( title ,,xviii ( ! ,social
 ,security ,act 7#db ,u4,s4,c4 #acie et 
seq47 or ! ,m$icaid program "u title    
,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et
 seq474  7ii7 ,! exclusion "u clause 7i7
 does n apply to laws reg>d+ integrity1 
e?ics1 fraud1 or t subject a p]son to   
civil or crim9al p5alties4  7,c7 ,title 
,,vii ( ! ,civil ,rights ,act ( #aifd   
7#db ,u4,s4,c4 #bjjj;e et seq47 %all    
apply ) respect to a ,/ate home t ent]s 
into an agreem5t "u ?is section to !    
same ext5t z su* title applies ) respect
 to ! ,/ate home 9 provid+ c>e or       
s]vices ?r\gh an agreem5t or arrangem5t 
o!r ?an "u ?is section4  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$]al     
,regi/] n lat] ?an #cj days be=e su*    
date4  #aje4 ,dep>tm5t ( ,vet]ans       
,affairs electronic int]face = process+ 
( m$ical claims  7a7 ,electronic        
int]face ,n lat] ?an ! implem5tation    
date specifi$ 9 section #ajh7;a71 !     
,*ief ,in=mation ,(fic] ( ! ,dep>tm5t ( 
,vet]ans ,affairs %all ensure t !       
in=mation te*nology sy/em us$ by !      
,dep>tm5t to receive1 process1 & pay    
claims "u ! ,,va ,c>e 9 ! ,community    
,program e/abli%$ 9 section #agjc;,a (  
title #ch1 ,unit$ ,/ates ,code1 z add$  
by section #ajb1 & "u ,vet]ans ,c>e     
,agreem5ts e/abli%$ 9 section #agjc;,b (
 su* title1 z add$ by section #ajc1     
includes ! foll[+3  7#a7 ,a function    
?r\gh :i* a cov]$ non-,dep>tm5t heal?   
c>e provid] may submit all requir$ data 
& support+ in=mation requir$ = claims   
reimbursem5t ?r\gh electronic data      
int]*anges4  7#b7 ,an ability to        
automatically adjudicate claims4  7#c7  

,a c5traliz$ claims database t is       
accessible nationwide4  7#d7            
,integration ) ! relevant eligibility & 
au?orization in=mation te*nology sy/ems 
( ! ,dep>tm5t4  7#e7 ,ability = a cov]$ 
non-,dep>tm5t heal? c>e provid] to      
asc]ta9 ! /atus ( a p5d+ claim submitt$ 
by ! provid]1 receive in=mation reg>d+  
miss+ docum5tation or discrepancies t   
may imp$e claim process+ timel9es or    
result 9 rejection1 & receive           
notification :5 su* claim is accept$ =  
reimbursem5t or reject$4  7#f7 ,a claim 
review sy/em simil> to t us$ by ! ,c5t]s
 = ,m$ic>e  ,m$icaid ,s]vices1 z ( !    
date ( ! enactm5t ( ?is ,act1 to det]m9e
 ! appropriat5ess & accuracy ( paym5ts  
to provid]s & to ensure program         
integrity & ov]sight4  7b7 ,security &  
privacy ,! ,*ief ,in=mation ,(fic] %all 
also ensure t ! in=mation te*nology     
sy/em cov]$ "u subsection 7a7 meets !   
foll[+ crit]ia3  7#a7 ,su* sy/em %all be
 develop$ & implem5t$ 9 compliance ) all
 applicable laws1 regulations & ,f$]al  

,gov]nm5t /&>ds reg>d+ in=mation        
security1 privacy1 & accessibility4     
7#b7 ,su* sy/em %all provide = !        
elicitation1 analysis1 & prioritization 
( functional & nonfunctional in=mation  
security & privacy requirem5ts = su*    
sy/em1 includ+ security & privacy       
s]vices & ar*itectural requirem5ts      
relat+ to security & privacy bas$ on a  
?or\gh risk assessm5t ( all reasonably  
anticipat$ cyb] & noncyb] ?reats to !   
security & privacy ( electronic protect$
 heal? in=mation made available ?r\gh   
su* int]face4  7#c7 ,su* sy/em %all     
provide = ! elicitation1 analysis1 &    
prioritization ( secure developm5t      
requirem5ts relat+ to su* sy/em4  7#d7  
,su* sy/em %all provide assurance t !   
prioritiz$ in=mation security & privacy 
requirem5ts ( su* sy/em--  7,a7 are     
correctly implem5t$ 9 ! design &        
implem5tation ( su* sy/em ?r\gh ! sy/ems
 developm5t lifecycle2 &  7,b7 satisfy !
 in=mation objectives ( su* sy/em relat+
 to security & privacy ?r\gh\t ! sy/ems 

developm5t lifecycle4  7c7 ,contract    
au?ority ,! ,*ief ,in=mation ,(fic] may 
ent] into a contract = purposes ( c>ry+ 
out ?is section4  7d7 ,def9itions ,9 ?is
 section3  7#a7 ,! t]m electronic       
protect$ heal? in=mation has ! mean+    
giv5 t t]m 9 section #afj4ajc ( title   
#de1 ,code ( ,f$]al ,regulations1 z 9   
effect on ! date ( ! enactm5t ( ?is     
,act4  7#b7 ,! t]m cov]$ non-,dep>tm5t  
heal? c>e provid] means-- 7,a7 a network
 provid] 7z def9$ by section #agja7aa7 (
 title #ch1 ,unit$ ,/ates ,code1 z add$ 
by section #ajb72  7,b7 a non-network   
provid] ) :i* ! ,secret>y has ent]$ into
 a ,vet]ans ,c>e ,agreem5t "u section   
#agjc;,b ( su* title1 z add$ by section 
#ajc2 or  7,c7 any o!r non-,dep>tm5t    
eligible provid] or non-,dep>tm5t heal? 
c>e provid] t furni%es hospital c>e or  
m$ical s]vices pursuant to *apt] #ag (  
su* title4  7#c7 ,! t]m secure          
developm5t requirem5ts means1 ) respect 
to ! in=mation te*nology sy/em e/abli%$ 
"u subsection 7a71 activities t are     

requir$ to be complet$ dur+ ! sy/em     
developm5t lifecycle ( su* int]face1 su*
 z secure cod+ pr9ciples & te/          
me?odologies4  7#d7 ,! t]m ,,va ,c>e 9 !
 ,community ,program has ! mean+ giv5 t 
t]m 9 section #agja7ab7 ( title #ch1    
,unit$ ,/ates ,code1 z add$ by section  
#ajb4  #ajf4 ,fund+ = ,,va ,c>e 9 !     
,community ,program  7a7 ,9 g5]al ,all  
am\nts requir$ to c>ry out ! ,,va ,c>e 9
 ! ,community ,program & ,vet]ans ,c>e  
,agreem5ts "u section #agjc;,b ( title  
#ch1 ,unit$ ,/ates ,code1 %all be d]iv$ 
f ! ,vet]ans ,heal? ,adm9i/ration1      
,m$ical ,community ,c>e acc\nt4  7b7    
,transf] ( am\nts  7#a7 ,9 g5]al ,any   
unobligat$ am\nts 9 ! ,vet]ans ,*oice   
,fund "u section #hjb ( ! ,vet]ans      
,access1 ,*oice1 & ,acc\ntability ,act (
 #bjad 7,public ,law #aac-adf2 #ch      
,u4,s4,c4 #agja note7 %all be transf]r$ 
to ! ,vet]ans ,heal? ,adm9i/ration1     
,m$ical ,community ,c>e acc\nt on ! lat]
 ( ! foll[+ dates3  7,a7 ,! date t is "o
 ye> aft] ! date ( ! enactm5t ( ?is     

,act4  7,b7 ,! date on :i* ! ,secret>y (
 ,vet]ans ,affairs submits to !         
,committees on ,vet]ans' ,affairs ( !   
,s5ate & ! ,h\se ( ,repres5tatives !    
c]tification requir$ by section         
#ajg7;c74  7#b7 ,con=m+ repeal  7,a7 ,9 
g5]al ,effective imm$iately foll[+ !    
transf] ( am\nts "u p>agraph 7#a71      
section #hjb ( ! ,vet]ans ,access1      
,*oice1 & ,acc\ntability ,act ( #bjad   
7,public ,law #aac-adf2 #ch ,u4,s4,c4   
#agja note7 is repeal$4  7,b7 ,con=m+   
am5dm5t ,section #djjc ( ! ,surface     
,transportation & ,vet]ans ,heal? ,c>e  
,*oice ,improvem5t ,act ( #bjae 7,public
 ,law #aad-da2 #ch ,u4,s4,c4 #agja note7
 is am5d$ by /rik+ = non-,dep>tm5t      
provid] programs 7z def9$ 9 section     
#b7;d77 & all t foll[s ?r\gh #ahjb7 &   
ins]t+ ! foll[+3 = ! ,,va ,c>e 9 !      
,community ,program 7z def9$ 9 section  
#agja7ab7 ( title #ch1 ,unit$ ,/ates    
,code7 & ,vet]ans ,c>e ,agreem5ts "u    
section #agjc;,b ( title #ch1 ,unit$    
,/ates ,code4  7c7 ,,va ,c>e 9 !        

,community ,program def9$ ,9 ?is        
section1 ! t]m ,,va ,c>e 9 ! ,community 
,program has ! mean+ giv5 t t]m 9       
section #agja7ab7 ( title #ch1 ,unit$   
,/ates ,code1 z add$ by section #ajb4   
#ajg4 ,t]m9ation ( c]ta9 provisions     
au?oriz+ m$ical c>e to vet]ans ?r\gh    
non-,dep>tm5t ( ,vet]ans ,affairs       
provid]s  7a7 ,t]m9ation ( au?ority ,to 
contract = c>e 9 non-,dep>tm5t          
facilities  7#a7 ,9 g5]al ,section #agjc
 ( title #ch1 ,unit$ ,/ates ,code1 is   
am5d$ by add+ at ! end ! foll[+ new     
subsection3  7e7 ,! au?ority ( !        
,secret>y to c>ry out ?is section       
t]m9ates on ! date on :i* ! ,secret>y   
c]tifies to ! ,committees on ,vet]ans'  
,affairs ( ! ,h\se ( ,repres5tatives & !
 ,s5ate t ! ,secret>y is fully implem5t+
 section #agjc;,a ( ?is title4  4  7#b7 
,con=m+ am5dm5ts  7,a7 ,d5tal c>e       
,section #agab7;a7 ( su* title is       
am5d$-- 7i7 9 p>agraph 7#c71 by /rik+ "u
 clause 7#a71 7#b71 or 7#e7 ( section   
#agjc7;a7 ( ?is title & ins]t+ "u ! ,,va

 ,c>e 9 ! ,community ,program2 &  7ii7 9
 p>agraph 7#d77;,a71 9 ! fir/ s5t5ce--  
7,i7 by /rik+ & section #agjc ( ?is     
title & ins]t+ & ! ,,va ,c>e 9 !        
,community ,program 7) respect to su* a 
ye> beg9n+ on or aft] ! date on :i* !   
,secret>y comm5ces implem5tation ( !    
,,va ,c>e 9 ! ,community ,program72 &   
7,,ii7 by /rik+ 9 section #agjc ( ?is   
title & ins]t+ "u ! ,,va ,c>e 9 !       
,community ,program4  7,b7 ,readju/m5t  
c\nsel+ ,section #agab;,a7e77#a7 ( su*  
title is am5d$ by /rik+ 7"u sections    
#agjc7;a77#b7 & #agaj7;a77#a77;,b7 ( ?is
 title7 & ins]t+ 7"u ! ,,va ,c>e 9 !    
,community ,program74  7,c7 ,dea? 9     
,dep>tm5t facility ,section             
#bcjc7;a77#b77;,b77i7 ( su* title is    
am5d$ by /rik+ 9 accordance ) section   
#agjc ( ?is title & ins]t+ "u ! ,,va    
,c>e 9 ! ,community ,program4  7,d7     
,m$ic>e provid] agreem5ts ,section      
#ahff7;a77#a77,l7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77
 is am5d$--  7i7 by /rik+ "u section    

#agjc ( title #ch & ins]t+ "u ! ,,va    
,c>e 9 ! ,community ,program 7z def9$ 9 
section #agja7ab7 ( title #ch1 ,unit$   
,/ates ,code72 &  7ii7 by /rik+ su*     
section & ins]t+ su* program4  7b7      
,repeal ( au?ority ,to contract = sc>ce 
m$ical speciali/s  7#a7 ,9 g5]al        
,section #gdji ( title #ch1 ,unit$      
,/ates ,code1 is repeal$4  7#b7 ,cl]ical
 am5dm5t ,! table ( sections at ! beg9n+
 ( *apt] #gd ( su* title is am5d$ by    
/rik+ ! item relat+ to section #gdji4   
7c7 ,effective date ,! am5dm5ts made by 
subsections 7a7 & 7b7 %all take effect  
on ! date on :i* ! ,secret>y c]tifies to
 ! ,committees on ,vet]ans' ,affairs ( !
 ,h\se ( ,repres5tatives & ! ,s5ate t ! 
,secret>y is fully implem5t+ section    
#agjc;,a ( title #ch1 ,unit$ ,/ates     
,code1 z add$ by section #ajb4  #ajh4   
,implem5tation & transition  7a7        
,implem5tation ,! ,secret>y ( ,vet]ans  
,affairs %all comm5ce ! implem5tation ( 
section #agjc;,a ( title #ch1 ,unit$    
,/ates ,code1 z add$ by section #ajb1 & 

section #agjc;,b ( su* title1 z add$ by 
section #ajc1 & %all make ! transf] "u  
section #ajf7;b71 by n lat] ?an "o ye>  
aft] ! date ( ! enactm5t ( ?is ,act4 ,! 
,secret>y %all prescribe int]im f9al    
regulations to implem5t su* sections &  
publi% su* regulations 9 ! ,f$]al       
,regi/]4  7b7 ,tra9+ ,be=e comm5c+ !    
implem5tation ( sections #agjc;,a &     
#agjc;,b ( title #ch1 ,unit$ ,/ates     
,code1 z add$ by sections #ajb & #ajc1  
respectively1 ! ,secret>y ( ,vet]ans    
,affairs %all--  7#a7 c]tify to !       
,committees on ,vet]ans' ,affairs ( !   
,h\se ( ,repres5tatives & ! ,s5ate t--  
7,a7 ea* network provid] 7z def9$ by    
section #agja7aa7 ( title #ch1 ,unit$   
,/ates ,code7 & eligible non-network    
provid] t furni%es c>e or s]vices "u su*
 section #agjc;,a or section #agjc;,b is
 tra9$ to furni% su* c>e or s]vices "u  
su* sections2 &  7,b7 ea* employee ( !  
,dep>tm5t t ref]s1 au?orizes1 or        
coord9ates su* c>e or s]vices is tra9$  
to c>ry out su* sections2 &  7#b7       

e/abli% /&>d1 writt5 guidance = network 
provid]s1 non-,dep>tm5t heal? c>e       
provid]s1 & any non-,dep>tm5t           
adm9i/rative entities act+ on behalf (  
su* provid]s1 ) respect to ! policies & 
proc$ures = furni%+ c>e or s]vices "u   
su* sections4  ,,ii ,o!r adm9i/rative   
matt]s  #bja4 ,reimbursem5t = em]g5cy   
ambulance s]vices  7a7 ,9 g5]al ,section
 #agbe7;c7 ( title #ch1 ,unit$ ,/ates   
,code1 is am5d$ by add+ at ! end !      
foll[+ new p>agraph3  7#e7 ,9 del9eat+ !
 circum/ances "u :i* reimbursem5t may be
 made "u ?is section = ambulance s]vices
 = an individual1 ! ,secret>y %all treat
 su* s]vices z em]g5cy s]vices = :i*    
reimbursem5t may be made "u ?is section 
if ! ,secret>y det]m9es t--  7,a7 !     
reque/ = ambulance s]vices 0 made z a   
result ( ! sudd5 onset ( a m$ical       
condition ( su* a nature t a prud5t     
layp]son :o possesses an av]age k (     
heal? & m$ic9e--  7i7 w\ld h reasonably 
expect$ t a delay 9 seek+ imm$iate      
m$ical att5tion w\ld h be5 haz>d\s to ! 

life or heal? ( ! individual2 or  7ii7  
c\ld reasonably expect ! abs5ce (       
imm$iate m$ical att5tion to result 9    
plac+ ! heal? ( ! individual 9 s]i\s    
jeop>dy1 ! s]i\s impairm5t ( bodily     
functions1 or ! s]i\s dysfunction ( any 
bodily organ or "p2 &  7,b7 ! individual
 is transport$ to ! mo/ appropriate     
m$ical facility capable ( treat+ su*    
m$ical condition4  4  7b7 ,effective    
date ,! am5dm5t made by subsection 7a7  
%all take effect on ! date ( ! enactm5t 
( ?is ,act & %all apply ) respect to    
ambulance s]vices provid$ on or aft]    
,janu>y #a1 #bjai4  #bjb4 ,improvem5t ( 
c>e coord9ation = vet]ans ?r\gh ex*ange 
( c]ta9 m$ical records ,section         
#gccb7;b7 ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$-- 7#a7 9 p>agraph 7#b71 
by add+ at ! end ! foll[+ new           
subp>agraphs3  7,h7 ,to a public or     
private heal? c>e provid] 9 ord] to     
provide treatm5t or heal? c>e to a %>$  
pati5t4  7,i7 ,to a ?ird p>ty 9 ord] to 
recov] or collect reasonable *>ges = c>e

 furni%$ to a vet]an = a                
non-s]vice-connect$ disability pursuant 
to section #agbi ( ?is title or section 
#a ( ,public ,law #hg-fic 7#db ,u4,s4,c4
 #bfea74  2 &  7#b7 by add+ at ! end !  
foll[+ new p>agraph3  7#d7 ,no?+ 9 ?is  
section %all be con/ru$ to au?orize any 
provision ( records 9 violation (       
relevant heal? record privacy laws1     
includ+ ! ,heal? ,insurance ,portability
 & ,acc\ntability ,act ( #aiif 7,public 
,law #ajd-aia74  4  #bjc4 ,elim9ation ( 
copaym5t (fset  7a7 ,9 g5]al ,section   
#agbi7;a7 ( title #ch1 ,unit$ ,/ates    
,code1 is am5d$ by add+ at ! end !      
foll[+ new p>agraph3  7#d7 ,not)/&+ any 
o!r provision ( law1 any am\nt t !      
,unit$ ,/ates may collect or recov] "u  
?is section %all n affect any copaym5t  
am\nt a vet]an is o!rwise obligat$ to   
pay "u ?is *apt]4  4  7b7 ,effective    
date ,! am5dm5t made by subsection 7a7  
%all take effect on ! date ( ! enactm5t 
( ?is ,act & apply ) respect to a       
copaym5t obligation t arises on or aft] 

! date ( ! enactm5t ( ?is ,act4  #bjd4  
,use ( ,dep>tm5t ( ,vet]ans ,affairs    
,m$ical ,c>e ,collections ,fund = c]ta9 
improvem5ts 9 collections ,section      
#agbi;,a7c77#a77;,b7 ( title #ch1 ,unit$
 ,/ates ,code1 is am5d$ by ins]t+       
7includ+ ) respect to automatic data    
process+ or in=mation te*nology         
improvem5ts7 aft] collection4  #bje4    
,dep>tm5t ( ,vet]ans ,affairs heal? c>e 
productivity improvem5t  7a7 ,9 g5]al   
,sub*apt] ,i ( *apt] #ag ( title #ch1   
,unit$ ,/ates ,code1 is fur!r am5d$ by  
ins]t+ aft] section #agje;,a ! foll[+   
new section3  #agje;,b4 ,managem5t (    
heal? c>e3 productivity  7a7 ,relative  
value unit track+ ,! ,secret>y %all     
track relative value units = all        
,dep>tm5t provid]s4  7b7 ,cl9ical       
proc$ure cod+ tra9+ ,! ,secret>y %all   
require all ,dep>tm5t provid]s to att5d 
tra9+ on cl9ical proc$ure cod+4  7c7    
,p]=mance /&>ds ,! ,secret>y %all       
e/abli% = ea* ,dep>tm5t facility-- 7#a7 
/&>diz$ p]=mance /&>ds bas$ on          

nationally recogniz$ relative value unit
 production /&>ds applicable to ea*     
specific pr(ession 9 ord] to evaluate   
cl9ical productivity at ! provid] &     
facility level2  7#b7 rem$iation plans  
to address l[ cl9ical productivity &    
cl9ical ineffici5cy2 &  7#c7 an ongo+   
process to sy/ematically review !       
cont5t1 implem5tation1 & outcome ( !    
plans develop$ "u p>agraph 7#b74  7d7   
,def9itions ,9 ?is section3 7#a7 ,! t]m 
,dep>tm5t provid] means an employee ( ! 
,dep>tm5t ^: prim>y responsibilities    
include furni%+ hospital c>e or m$ical  
s]vices1 includ+ a physician1 a d5ti/1  
an optometri/1 a podiatri/1 a           
*iropractor1 an advanc$ practice regi/]$
 nurse1 & a physician's assi/ant act+ z 
an indep5d5t provid]4  7#b7 ,! t]m      
relative value unit means a unit =      
measur+ workload by det]m9+ ! "t1 m5tal 
ef=t & judgm5t1 te*nical skill1 physical
 ef=t1 & /ress involv$ 9 deliv]+ a      
proc$ure4  4  7b7 ,cl]ical am5dm5t ,!   
table ( sections at ! beg9n+ ( su* *apt]

 is fur!r am5d$ by ins]t+ aft] ! item   
relat+ to section #agje;,a ! foll[+ new 
item3  #agje;,b4 ,managem5t ( heal? c>e3
 productivity4  4  7c7 ,report ,n lat]  
?an "o ye> aft] ! date ( ! enactm5t (   
?is ,act1 ! ,secret>y %all submit to    
,congress a report on ! implem5tation ( 
section #agje;,b ( title #ch1 ,unit$    
,/ates ,code1 z add$ by subsection 7a74 
,su* report %all include1 = ea*         
pr(essional category ( ,dep>tm5t        
provid]s1 ! relative value unit ( su*   
category ( provid]s at ! national1      
,vet]ans ,integrat$ ,s]vice ,network1 & 
facility levels4  #bjf4 ,lic5sure (     
heal? c>e pr(essionals ( ! ,dep>tm5t (  
,vet]ans ,affairs provid+ treatm5t via  
telem$ic9e  7a7 ,9 g5]al ,*apt] #ag (   
title #ch1 ,unit$ ,/ates ,code1 is fur!r
 am5d$ by ins]t+ aft] section #agcj;,a !
 foll[+ new section3  #agcj;,b4         
,lic5sure ( heal? c>e pr(essionals      
provid+ treatm5t via telem$ic9e  7a7 ,9 
g5]al ,not)/&+ any provision ( law      
reg>d+ ! lic5sure ( heal? c>e           

pr(essionals1 a cov]$ heal? c>e         
pr(essional may practice ! heal? c>e    
pr(ession ( ! heal? c>e pr(essional at  
any location 9 any ,/ate1 reg>dless (   
:]e ! cov]$ heal? c>e pr(essional or !  
pati5t is locat$1 if ! cov]$ heal? c>e  
pr(essional is us+ telem$ic9e to provide
 treatm5t to an individual "u ?is *apt]4
  7b7 ,prop]ty ( f$]al gov]nm5t         
,subsection 7a7 %all apply to a cov]$   
heal? c>e pr(essional provid+ treatm5t  
to a pati5t reg>dless ( :e!r ! cov]$    
heal? c>e pr(essional or pati5t is      
locat$ 9 a facility own$ by ! ,f$]al    
,gov]nm5t dur+ su* treatm5t4  7c7       
,con/ruction ,no?+ 9 ?is section may be 
con/ru$ to remove1 limit1 or o!rwise    
affect any obligation ( a cov]$ heal?   
c>e pr(essional "u ! ,controll$         
,sub/ances ,act 7#ba ,u4,s4,c4 #hja et  
seq474  7d7 ,cov]$ heal? c>e pr(essional
 def9$ ,9 ?is section1 ! t]m cov]$ heal?
 c>e pr(essional means a heal? c>e      
pr(essional :o-- 7#a7 is an employee ( !
 ,dep>tm5t appo9t$ "u ! au?ority "u     

section #gcjf1 #gdja1 #gdje1 #gdjf1 or  
#gdjh ( ?is title1 or title #e2  7#b7 is
 au?oriz$ by ! ,secret>y to provide     
heal? c>e "u ?is *apt]2  7#c7 is requir$
 to adh]e to all quality /&>ds relat+ to
 ! provision ( telem$ic9e 9 accordance )
 applicable policies ( ! ,dep>tm5t2 &   
7#d7 has an active1 curr5t1 full1 &     
unre/rict$ lic5se1 regi/ration1 or      
c]tification 9 a ,/ate to practice !    
heal? c>e pr(ession ( ! heal? c>e       
pr(essional4  4  7b7 ,cl]ical am5dm5t ,!
 table ( sections at ! beg9n+ ( *apt]   
#ag ( su* title is fur!r am5d$ by ins]t+
 aft] ! item relat+ to section #agcj;,a 
! foll[+ new item3  #agcj;,b4 ,lic5sure 
( heal? c>e pr(essionals provid+        
treatm5t via telem$ic9e4  4  7c7 ,report
 on telem$ic9e  7#a7 ,9 g5]al ,n lat]   
?an "o ye> aft] ! date ( ! enactm5t (   
?is ,act1 ! ,secret>y ( ,vet]ans        
,affairs %all submit to ! ,committee on 
,vet]ans' ,affairs ( ! ,s5ate & !       
,committee on ,vet]ans' ,affairs ( !    
,h\se ( ,repres5tatives a report on !   

effectiv5ess ( ! use ( telem$ic9e by !  
,dep>tm5t ( ,vet]ans ,affairs4  7#b7    
,elem5ts ,! report requir$ by p>agraph  
7#a7 %all include an assessm5t ( !      
foll[+3 7,a7 ,! satisfaction ( vet]ans )
 telem$ic9e furni%$ by ! ,dep>tm5t4     
7,b7 ,! satisfaction ( heal? c>e        
provid]s 9 provid+ telem$ic9e furni%$ by
 ! ,dep>tm5t4  7,c7 ,! effect (         
telem$ic9e furni%$ by ! ,dep>tm5t on !  
foll[+3  7i7 ,! ability ( vet]ans to    
access heal? c>e1 :e!r f ! ,dep>tm5t or 
f non-,dep>tm5t heal? c>e provid]s4     
7ii7 ,! frequ5cy ( use by vet]ans (     
telem$ic9e4  7iii7 ,! productivity (    
heal? c>e provid]s4  7iv7 ,wait times = 
an appo9tm5t = ! receipt ( heal? c>e f !
 ,dep>tm5t4  7v7 ,! r$uction1 if any1 9 
! use by vet]ans ( 9-p]son s]vices at   
,dep>tm5t facilities & non-,dep>tm5t    
facilities4  7,d7 ,! types ( appo9tm5ts 
= ! receipt ( telem$ic9e furni%$ by !   
,dep>tm5t t 7 provid$ dur+ ! "o-ye>     
p]iod prec$+ ! submittal ( ! report4    
7,e7 ,! numb] ( appo9tm5ts = ! receipt (

 telem$ic9e furni%$ by ! ,dep>tm5t t 7  
reque/$ dur+ su* p]iod1 disaggregat$ by 
,vet]ans ,integrat$ ,s]vice ,network4   
7,f7 ,sav+s by ! ,dep>tm5t1 if any1     
includ+ travel co/s1 ( furni%+ heal? c>e
 ?r\gh ! use ( telem$ic9e dur+ su*      
p]iod4