,,ib ,union ,cal5d> ,no4 #ddd #aae? ,,congress #b;d ,session ,h4 ,r4 #dbdb ,report ,no4 #aae-ehe ,,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 ,m>* #e1 #bjah;,additional sponsors3 ,mr4 ,emm]1 ,mr4 ,/ew>t1 ,mr4 ,mess]1 ,mr4 ,hudson1 ,mr4 ,johnson ( ,ohio1 & ,mr4 ,web/] ( ,florida ,m>* #e1 #bjah ,report$ ) an am5dm5t1 committ$ to ! ,committee ( ! ,:ole ,h\se on ! ,/ate ( ! ,union1 & ord]$ to be pr9t$ ,/rike out all aft] ! enact+ clause & ins]t ! "p pr9t$ 9 italic ,= text ( introduc$ bill1 see copy ( bill z introduc$ on ,novemb] #c1 #bjag ,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$ical c>e to vet]ans ?r\gh non-,dep>tm5t ( ,vet]ans ,affairs provid]s4 ,sec4 #ajh4 ,implem5tation & transition4 ,sec4 #aji4 ,transplant proc$ures ) live donors & relat$ s]vices4 ,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$ic9e4 ,sec4 #bjg4 ,e/abli%m5t ( processes to ensure safe opioid prescrib+ practices by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s4 ,sec4 #bjh4 ,assessm5t ( heal? c>e furni%$ by ! ,dep>tm5t to vet]ans :o live 9 ! t]ritories4 ,sec4 #bji4 ,ov]sight & acc\ntability ( f9ancial processes ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #baj4 ,au?ority = ,dep>tm5t ( ,vet]ans ,affairs ,c5t] = ,innovation = ,c>e & ,paym5t4 ,title ,,iii--,improvem5ts to ,recruitm5t ( ,physicians ,sec4 #cja4 ,designat$ s*ol>%ips = physicians & d5ti/s "u ,dep>tm5t ( ,vet]ans ,affairs ,heal? ,pr(essional ,s*ol>%ip ,program4 ,sec4 #cjb4 ,e/abli%m5t ( ,dep>tm5t ( ,vet]ans ,affairs ,specialty ,education ,loan ,repaym5t ,program4 ,sec4 #cjc4 ,vet]ans heal+ vet]ans m$ical access & s*ol>%ip program4 ,i ,improv$ 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$4 7,b7 ,! ,secret>y may ent] into "o or m contracts = ! purposes ( manag+ ! op]ations ( ! regional networks & = ! deliv]y ( c>e pursuant to ?is section4 7,c7 ,! ,secret>y %all-- 7i7 v]ify ^u enrollm5t1 & annually !reaft]1 t network provid]s h n be5 exclud$ f p>ticipation 9 o!r f$]ally fund$ heal? c>e programs2 & 7ii7 submit to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate an annual report on ! results ( su* v]ifications4 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 7iv7 ,:e!r ! vet]an resides 9 a ,/ate :]e ! ,dep>tm5t does n op]at$ a full-s]vice m$ical facility4 7,c7 ,if ! ,secret>y det]m9es t a pati5t-align$ 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]2 7iii7 :e!r ! vet]an resides 9 a ,/ate :]e ! ,dep>tm5t does n op]ate a full-s]vice m$ical facility2 & 7iv7 9 ! case ( a vet]an :o requires an organ or bone m>r[ transplant1 :e!r ! vet]an has1 9 ! op9ion ( ! prim>y c>e provid] ( ! vet]an1 a m$ically compell+ reason to travel outside ! region ( ! ,organ ,procurem5t & ,transplantation ,network1 e/abli%$ "u section #cgb ( ! ,national ,organ ,transplantation ,act 7,public ,law #ih-ejg2 #db ,u4,s4,c4 #bgd71 9 :i* ! vet]an resides1 to receive su* transplant4 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 may give def]5ce to ! vet]an ) respect to any det]m9ation "u subsection 7b77#a77;,b77ii74 7,g7 7i7 ,! ,secret>y %all develop proc$ures to ensure t assign+ a vet]an to a pati5t-align$ c>e team or d$icat$ prim>y c>e provid] "u subp>agraph 7,a71 7,c71 or 7,d7 does n adv]sely affect ! cont9uity or quality ( c>e = ! vet]an dur+ ! transition4 7ii7 ,proc$ures "u clause 7i7 %all provide =-- 7,i7 ! appo9tm5t ( a contact 9 ! ,dep>tm5t = ! vet]an :o %all provide in=mation to ! vet]an & resolve issues reg>d+ ! transition2 7,,ii7 ! transf] ( relevant m$ical records2 7,,iii7 coord9ation ( c>e betwe5 provid]s2 7,,iv7 ! cont9u$ treatm5t ( *ronic or curr5t episodes ( c>e 7by means includ+ m$ication1 subspecialty c>e1 & ancill>y s]vices72 & 7,v7 any o!r action ! ,secret>y det]m9es is necess>y4 7c7 ,episodes ( c>e 7#a7 ,! ,secret>y %all ensure t1 at ! election ( an eligible vet]an :o receives hospital c>e1 m$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 7#c7 ,! ,secret>y %all-- 7,a7 v]ify ^u enrollm5t1 & annually !reaft]1 t eligible provid]s h n be5 exclud$ f p>ticipation 9 o!r f$]ally fund$ heal? c>e programs2 & 7,b7 submit to ! ,committees on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives & ! ,s5ate an annual report on ! results ( su* v]ifications4 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 includ+ ! use ( contractors to p]=m audits ?r\gh data analytics1 to det]m9e ! appropriat5ess & accuracy ( claims ( 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$ical c>e to vet]ans ?r\gh non-,dep>tm5t ( ,vet]ans ,affairs provid]s 7a7 ,t]m9ation ( au?ority ,to contract = c>e 9 non-,dep>tm5t facilities 7#a7 ,9 g5]al ,section #fjc( title #ch1 ,unit$ ,/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$ures = furni%+ c>e or s]vices "u su* sections4 #aji4 ,transplant proc$ures ) live donors & relat$ s]vices 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 is fur!r am5d$ by ins]t+ aft] section #agjc;,b1 z add$ by section #ajc1 ! foll[+ new section3 #agjc;,c4 ,transplant proc$ures ) live donors & relat$ s]vices 7a7 ,9 g5]al ,subject to subsections 7b7 & 7c71 9 a case 9 :i* a vet]an is eligible = a transplant proc$ure f ! ,dep>tm5t1 ! ,secret>y may provide = an op]ation on a live donor to c>ry out su* proc$ure = su* vet]an1 not)/&+ t ! live donor may n be eligible = heal? c>e f ! ,dep>tm5t4 7b7 ,o!r s]vices ,subject to ! availability ( appropriations = su* purpose1 ! ,secret>y %all furni% to a live donor any c>e or s]vices be=e & aft] conduct+ ! transplant proc$ure "u subsection 7a7 t may be requir$ 9 connection ) su* proc$ure4 7c7 ,use ( non-,dep>tm5t facilities 7#a7 ,9 c>ry+ out ?is subsection1 ! ,secret>y may provide = ! op]ation describ$ 9 subsection 7a7 on a live donor & furni% to ! live donor ! c>e & s]vices describ$ 9 subsection 7b7 at a non-,dep>tm5t facility pursuant to an agreem5t ent]$ into by ! ,secret>y "u ?is section4 ,! live donor %all be deem$ to be an individual eligible = hospital c>e & m$ical s]vices at a non-,dep>tm5t facility pursuant to su* an agreem5t solely = ! purposes ( receiv+ su* op]ation1 c>e1 & s]vices at ! non-,dep>tm5t facility4 7#b7 ,! ,secret>y may only provide = an op]ation at a non-,dep>tm5t ( ,vet]ans ,affairs transplant c5t] pursuant to p>agraph 7#a7 if ! c5t] is 9 compliance ) regulations prescrib$ by ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices applicable to transplant c5t]s4 4 7b7 ,cl]ical am5dm5t ,! table ( section at ! beg9n+ ( su* *apt] is fur!r am5d$ by ins]t+ aft] ! item relat+ to section #agjc;,b1 z add$ by section #ajc1 ! foll[+ new item3 #agjc;,c4 ,transplant proc$ures ) live donors & relat$ s]vices4 4 ,,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$-- 7#a7 9 p>agraph 7#b71 by add+ at ! end ! foll[+ new subp>agraphs3 7,i7 ,to a public or private heal? c>e provid] 9 ord] to provide treatm5t or heal? c>e to a %>$ pati5t4 7,j7 ,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 7#a7 ,! ,secret>y %all e/abli% = ea* ,dep>tm5t facility-- 7,a7 9 accordance ) p>agraph 7#b71 /&>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 subp>agraph 7,b74 7#b7 ,9 e/abli%+ ! p]=mance /&>ds "u p>agraph 7#a77;,a71 ! ,secret>y may-- 7,a7 incorporate values-bas$ productivity models2 & 7,b7 take into acc\nt non-cl9ical duties1 includ+ ) respect to tra9+ & rese>*4 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$ic9e dur+ su* p]iod4 #bjg4 ,e/abli%m5t ( processes to ensure safe opioid prescrib+ practices by non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid]s 7a7 ,receipt & review ( guidel9es ,! ,secret>y ( ,vet]ans ,affairs %all ensure t all cov]$ heal? c>e provid]s are provid$ a copy ( & c]tify t !y h review$ ! evid5ce-bas$ guidel9es = prescrib+ opioids set =? by ! ,opioid ,safety ,initiative ( ! ,dep>tm5t ( ,vet]ans ,affairs "u sections #iaa7;a77#b7 & #iab7;c7 ( ! ,jason ,simcakoski ,memorial & ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note7 be=e fir/ provid+ c>e "u ! laws adm9i/]$ by ! ,secret>y & at any "t :5 ^? guidel9es are modifi$ !reaft]4 7b7 ,inclusion ( m$ical hi/ory & curr5t m$ications ,! ,secret>y %all implem5t a process to ensure t1 if c>e ( a vet]an by a cov]$ heal? c>e provid] is au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y1 ! docum5t au?oriz+ su* c>e includes ! relevant m$ical hi/ory ( ! vet]an & a li/ ( all m$ications prescrib$ to ! vet]an4 7c7 ,submittal ( prescriptions 7#a7 ,9 g5]al ,except z provid$ 9 p>agraph 7#c71 ! ,secret>y %all require1 to ! maximum ext5t practicable1 ea* cov]$ heal? c>e provid] to submit prescriptions = opioids-- 7,a7 to ! ,dep>tm5t = prior au?orization = ! prescrib+ ( a limit$ am\nt ( opioids "u contracts ! ,dep>tm5t has ) retail ph>macies2 or 7,b7 directly to a ph>macy ( ! ,dep>tm5t = ! disp5s+ ( su* prescription4 7#b7 ,dep>tm5t responsibility ,9 c>ry+ out p>agraph 7#a71 ^u receipt by ! ,dep>tm5t ( a prescription = opioids = a vet]an "u ! laws adm9i/]$ by ! ,secret>y1 ! ,secret>y %all-- 7,a7 record su* prescription 9 ! electronic heal? record ( ! vet]an2 & 7,b7 monitor su* prescription z outl9$ 9 ! ,opioid ,safety ,initiative ( ! ,dep>tm5t4 7#c7 ,exception 7,a7 ,9 g5]al ,a cov]$ heal? c>e provid] is n requir$ "u p>agraph 7#a77;,b7 to submit an opioid prescription directly to a ph>macy ( ! ,dep>tm5t if-- 7i7 ! heal? c>e provid] det]m9es t !re is an imm$iate m$ical ne$ = ! prescription1 includ+ an urg5t or em]g5t prescription or a prescription disp5s$ z "p ( an opioid treatm5t program t provides (fice-bas$ m$ications2 & 7ii7 7,i7 foll[+ an inquiry into ! matt]1 a ph>macy ( ! ,dep>tm5t notifies ! heal? c>e provid] t x _c fill ! prescription 9 a timely mann]2 or 7,,ii7 ! heal? c>e provid] det]m9es t ! requirem5t "u p>agraph 7#a77;,b7 w\ld impose an undue h>d%ip on ! vet]an1 includ+ ) respect to travel di/ances1 z det]m9$ by ! ,secret>y4 7,b7 ,notification to ,dep>tm5t ,if a cov]$ heal? c>e provid] uses an exception "u subp>agraph 7,a7 ) respect to an opioid prescription = a vet]an1 ! heal? c>e provid] %all1 on ! same day ! prescription is writt51 submit to ! ,secret>y = inclusion 9 ! electronic heal? record ( ! vet]an a notice1 9 su* =m z ! ,secret>y may e/abli%1 provid+ in=mation ab\t ! prescription & describ+ ! reason = ! exception4 7,c7 ,report 7i7 ,9 g5]al ,n less frequ5tly ?an qu>t]ly1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report evaluat+ ! compliance ( cov]$ heal? c>e provid]s ) ! requirem5ts "u ?is p>agraph & sett+ =? data on ! use by heal? c>e provid]s ( exceptions "u subp>agraph 7,a7 & notices "u subp>agraph 7,b74 7ii7 ,elem5ts ,ea* report requir$ by clause 7i7 %all include ! foll[+ ) respect to ! qu>t] cov]$ by ! report3 7,i7 ,! numb] ( exceptions us$ "u subp>agraph 7,a7 & notices receiv$ "u subp>agraph 7,b74 7,,ii7 ,! rate ( compliance by ! ,dep>tm5t ) ! requirem5t "u subp>agraph 7,b7 to include su* notices 9 ! heal? records ( vet]ans4 7,,iii7 ,! id5tification ( any cov]$ heal? c>e provid]s t1 bas$ on crit]ia prescrib$ ! ,secret>y1 are det]m9$ by ! ,secret>y to be /ati/ical outli]s reg>d+ ! use ( exceptions "u subp>agraph 7,a74 7d7 ,use ( ,opioid ,safety ,initiative guidel9es 7#a7 ,9 g5]al ,if a director ( a m$ical c5t] ( ! ,dep>tm5t or a ,vet]ans ,integrat$ ,s]vice ,network det]m9es t ! opioid prescrib+ practices ( a cov]$ heal? c>e provid] conflicts ) or is o!rwise inconsi/5t ) ! /&>ds ( appropriate & safe c>e1 z t t]m is us$ 9 section #iac7;d7 ( ! ,jason ,simcakoski ,memorial & ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note71 ! director %all take su* action z ! director consid]s appropriate to ensure ! safety ( all vet]ans receiv+ c>e f t heal? c>e provid]1 includ+ remov+ or direct+ ! removal ( any su* heal? c>e provid] f provid] networks or o!rwise refus+ to au?orize c>e ( vet]ans by su* heal? c>e provid] 9 any program au?oriz$ "u ! laws adm9i/]$ by ! ,secret>y4 7#b7 ,inclusion 9 contracts ,! ,secret>y %all ensure t any contracts ent]$ into by ! ,secret>y ) ?ird p>ties involv$ 9 adm9i/]+ programs t provide c>e 9 ! community to vet]ans "u ! laws adm9i/]$ by ! ,secret>y specifically grant ! au?ority set =? 9 p>agraph 7#a7 to su* ?ird p>ties & to ! directors describ$ 9 t p>agraph1 z ! case may be4 7e7 ,d5ial or revocation ( eligibility ( non-,dep>tm5t provid]s ,! ,secret>y %all d5y or revoke ! eligibility ( a non-,dep>tm5t heal? c>e provid] to provide heal? c>e to vet]ans "u ! laws adm9i/]$ by ! ,secret>y if ! ,secret>y det]m9es t ! opioid prescrib+ practices ( ! provid]-- 7#a7 violate ! requirem5ts ( a m$ical lic5se ( ! heal? c>e provid]2 or 7#b7 detract f ! ability ( ! heal? c>e provid] to deliv] safe & appropriate heal? c>e4 7f7 ,cov]$ heal? c>e provid] def9$ ,9 ?is section1 ! t]m cov]$ heal? c>e provid] means a non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e provid] :o provides heal? c>e to vet]ans "u ! laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs4 #bjh4 ,assessm5t ( heal? c>e furni%$ by ! ,dep>tm5t to vet]ans :o live 9 ! t]ritories 7a7 ,9 g5]al ,n lat] ?an #ahj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committees on ,vet]ans' ,affairs ( ! ,s5ate & ! ,h\se ( ,repres5tatives a report reg>d+ heal? c>e furni%$ by ! ,dep>tm5t ( ,vet]ans ,affairs to vet]ans :o live 9 ! t]ritories4 7b7 ,elem5ts ,! report "u subsection 7a7 %all include assessm5ts ( ! foll[+3 7#a7 ,! ability ( ! ,dep>tm5t to furni% to vet]ans :o live 9 ! t]ritories ! foll[+3 7,a7 ,hospital c>e4 7,b7 ,m$ical s]vices4 7,c7 ,m5tal heal? s]vices4 7,d7 ,g]iatric s]vices4 7#b7 ,! feasibility ( e/abli%+ a m$ical facility ( ! ,dep>tm5t 9 any t]ritory t does n conta9 su* a facility4 7c7 ,def9ition ,9 ?is section1 ! t]m t]ritories means ! ,nor!rn ,m>iana ,isl&s1 ,pu]to ,rico1 ,am]ican ,samoa1 ,guam1 & ! ,virg9 ,isl&s4 #bji4 ,ov]sight & acc\ntability ( f9ancial processes ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,s5se ( ,congress ,x is ! s5se ( ,congress t-- 7#a7 ! normal budget process = ! ,dep>tm5t ( ,vet]ans ,affairs %\ld be gr\nd$ 9 s\nd actu>ial analysis bas$ on accurate dem& =eca/+2 7#b7 ! regul> budget process = ! ,dep>tm5t %\ld be ! norm2 7#c7 supplem5tal reque/s = appropriations %\ld be us$ sp>+ly & = un=ese5 dem& or natural occurr5ces2 & 7#d7 ^u receipt ( ! f9ancial audit ( ! ,(fice ( ,inspector ,g5]al ( ! ,dep>tm5t1 ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives %all give due consid]ation to ! report1 includ+ by hold+ he>+s z appropriate 7b7 ,plans = use ( supplem5tal appropriations requir$ ,:5ev] ! ,secret>y submits to address a budget>y issue affect+ ! ,dep>tm5t ( ,vet]ans ,affairs to ,congress a reque/ = supplem5tal appropriations or any o!r appropriation :5 ! reque/ is submitt$ outside ! /&>d budget process1 ! ,secret>y %all1 n lat] ?an #de days be=e ! date on :i* su* budget>y issue w\ld />t affect+ a program or s]vice1 submit to ,congress a ju/ification = ! reque/1 includ+ a plan t details h[ ! ,secret>y int5ds to use ! reque/$ appropriation & h[ long ! reque/$ appropriation is expect$ to meet ! ne$s ( ! ,dep>tm5t & c]tification t ! reque/ 0 made us+ an updat$ & s\nd actu>ial analysis4 7c7 ,annual atte/ation reg>d+ f9ancial projections ,concurr5t ) ! ,presid5t's annual budget reque/ submitt$ to ,congress "u section #aaje ( title #ca1 ,unit$ ,/ates ,code1 = fiscal ye> #bjai & ea* fiscal ye> !reaft]1 ! ,*ief ,f9ancial ,(fic] ( ! ,dep>tm5t ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives ! foll[+3 7#a7 ,a /atem5t ( assurance t f9ancial projections includ$ 9 su* budget or ! support+ mat]ials submitt$ along ) su* budget = ! ,dep>tm5t ( ,vet]ans ,affairs are suffici5t to provide b5efits & s]vices "u laws adm9i/]$ by ! ,secret>y ( ,vet]ans ,affairs4 7#b7 ,a c]tification ( ! ,*ief ,f9ancial ,(fic]'s responsibility = int]nal f9ancial controls ( ! ,dep>tm5t4 7#c7 ,an atte/ation t ! ,*ief ,f9ancial ,(fic] has collaborat$ suffici5tly ) ! f9ancial (fic]s ( ! facilities & compon5ts ( ! ,dep>tm5t to be confid5t 9 su* f9ancial projections4 #baj4 ,au?ority = ,dep>tm5t ( ,vet]ans ,affairs ,c5t] = ,innovation = ,c>e & ,paym5t 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag1 z am5d$ by section #ajc1 is fur!r am5d$ by ins]t+ aft] section #agjc;,c1 z add$ by section #aji1 ! foll[+ new section3 #agjc;,d4 ,c5t] = ,innovation = ,c>e & ,paym5t 7a7 ,9 g5]al 7#a7 ,!re is e/abli%$ )9 ! ,dep>tm5t a ,c5t] = ,innovation = ,c>e & ,paym5t 79 ?is section ref]r$ to z ! ,c5t]74 7#b7 ,! ,secret>y1 act+ ?r\gh ! ,c5t]1 may c>ry out su* pilot programs ! ,secret>y det]m9es to be appropriate to develop innovative approa*es to te/+ paym5t & s]vice deliv]y models 9 ord] to r$uce exp5ditures :ile pres]v+ or enhanc+ ! quality ( c>e furni%$ by ! ,dep>tm5t4 7#c7 ,! ,secret>y1 act+ ?r\gh ! ,c5t]1 %all te/ paym5t & s]vice deliv]y models to det]m9e :e!r su* models-- 7,a7 improve access to1 & quality1 timel9ess1 & pati5t satisfaction ( c>e & s]vices2 & 7,b7 create co/ sav+s = ! ,dep>tm5t4 7#d7 7,a7 ,! ,secret>y %all te/ a model 9 a location :]e ! ,secret>y det]m9es t ! model w addresses deficits 9 c>e 7includ+ poor cl9ical outcomes or pot5tially avoidable exp5ditures7 = a def9$ population4 7,b7 ,! ,secret>y %all focus on models ! ,secret>y expects to r$uce program co/s :ile pres]v+ or enhanc+ ! quality ( c>e receiv$ by individuals receiv+ b5efits "u ?is *apt]4 7,c7 ,! models select$ may include ^? describ$ 9 section #aaae;,a7b77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b774 7#e7 ,9 select+ a model = te/+1 ! ,secret>y may consid]1 9 addition to o!r factors id5tifi$ 9 ?is subsection1 ! foll[+ factors3 7,a7 ,:e!r ! model includes a regul> process = monitor+ & updat+ pati5t c>e plans 9 a mann] t is consi/5t ) ! ne$s & pref]5ces ( individuals receiv+ b5efits "u ?is *apt]4 7,b7 ,:e!r ! model places ! individual receiv+ b5efits "u ?is *apt] at ! c5t] ( ! c>e team 7includ+ family memb]s & o!r c>egiv]s7 ( su* individual4 7,c7 ,:e!r ! model uses te*nology or new sy/ems to coord9ate c>e ov] "t & across sett+s4 7,d7 ,:e!r ! model demon/rates effective l9kage ) o!r public sector pay]s1 private sector pay]s1 or /atewide paym5t models4 7#f7 7,a7 ,models te/$ "u ?is section may n be design$ 9 su* a way t w\ld all[ ! ,unit$ ,/ates to recov] or collect reasonable *>ges f a ,f$]al heal? c>e program = c>e or s]vices furni%$ by ! ,secret>y to a vet]an "u pilot programs c>ri$ out "u ?is section4 7,b7 ,9 ?is p>agraph1 ! t]m ,f$]al heal? c>e program means-- 7i7 an insurance program describ$ 9 section #ahaa ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7 or e/abli%$ by section #ahca ( su* ,act 7#db ,u4,s4,c4 #acie;j72 or 7ii7 a ,/ate plan = m$ical assi/ance approv$ "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq472 or 7iii7 a ,,tric>e program op]at$ "u sections #ajge1 #ajge;a1 #ajgf1 #ajgf;a1 #ajgf;c1 #ajgf;d1 #ajgf;e1 or #ajgf;f ( title #aj4 7b7 ,duration ,ea* pilot program c>ri$ out by ! ,secret>y "u ?is section %all t]m9ate no lat] ?an five ye>s aft] ! date ( ! comm5cem5t ( ! pilot program4 7c7 ,location ,! ,secret>y %all ensure t ea* pilot program c>ri$ out "u ?is section occurs 9 an area or areas appropriate = ! int5d$ purposes ( ! pilot program4 7d7 ,budget ,fund+ = ea* pilot program c>ri$ out by ! ,secret>y "u ?is section %all come f appropriations-- 7#a7 provid$ 9 advance 9 appropriations acts = ! ,vet]ans ,heal? ,adm9i/ration2 & 7#b7 provid$ = in=mation te*nology sy/ems4 7e7 ,notice ,! ,secret>y %all-- 7#a7 publi% in=mation ab\t ea* pilot program "u ?is section 9 ! ,f$]al ,regi/]2 & 7#b7 take reasonable actions to provide direct notice to vet]ans eligible to p>ticipate 9 su* pilot programs4 7f7 ,waiv] ( au?orities 7#a7 ,subject to report+ "u p>agraph 7#b7 & approval "u p>agraph 7#c71 9 implem5t+ a pilot program "u ?is section1 ! ,secret>y may waive su* requirem5ts 9 sub*apt]s ,i1 ,,ii1 & ,,iii ( ?is *apt] z ! ,secret>y det]m9es necess>y solely = ! purposes ( c>ry+ out ?is section ) respect to te/+ models describ$ 9 subsection 7a74 7#b7 ,be=e waiv+ any au?ority "u p>agraph 7#a71 ! ,secret>y %all submit a report to ! ,speak] ( ! ,h\se ( ,repres5tatives1 ! m9ority lead] ( ! ,h\se ( ,repres5tatives1 ! majority lead] ( ! ,s5ate1 ! m9ority lead] ( ! ,s5ate1 & ea* /&+ committee ) jurisdiction "u ! rules ( ! ,s5ate & ( ! ,h\se ( ,repres5tatives to report a bill to am5d ! provision or provisions ( law t w\ld be waiv$ by ! ,dep>tm5t describ+ 9 detail ! foll[+3 7,a7 ,! specific au?orities to be waiv$ "u ! pilot program4 7,b7 ,! /&>d or /&>ds to be us$ 9 ! pilot program 9 lieu ( ! waiv$ au?orities4 7,c7 ,! reasons = su* waiv] or waiv]s4 7,d7 ,a description ( ! metric or metrics ! ,secret>y w use to det]m9e ! effect ( ! waiv] or waiv]s ^u ! access to & quality1 timel9ess1 or pati5t satisfaction ( c>e & s]vices furni%$ ?r\gh ! pilot program4 7,e7 ,! anticipat$ co/ sav+s1 if any1 ( ! pilot program4 7,f7 ,! s*$ule = int]im reports on ! pilot program describ+ ! results ( ! pilot program s f> & ! feasibility & advisability ( cont9u+ ! pilot program4 7,g7 ,! s*$ule = ! t]m9ation ( ! pilot program & ! submission ( a f9al report on ! pilot program describ+ ! result ( ! pilot program & ! feasibility & advisability ( mak+ ! pilot program p]man5t4 7,h7 ,! e/imat$ budget ( ! pilot program4 7#c7 7,a7 ,^u receipt ( a report submitt$ "u p>agraph 7#b71 ea* ,h\se ( ,congress %all provide copies ( ! report to ! *airman & rank+ memb] ( ea* /&+ committee ) jurisdiction "u ! rules ( ! ,h\se ( ,repres5tatives or ! ,s5ate to report a bill to am5d ! provision or provisions ( law t w\ld be waiv$ by ! ,dep>tm5t "u ?is subsection4 7,b7 7i7 ,! waiv] reque/$ by ! ,secret>y "u p>agraph 7#b7 %all be consid]$ approv$ "u ?is p>agraph if !re is enact$ into law a bill or jo9t resolution approv+ su* reque/ 9 its entirety4 ,su* bill or jo9t resolution %all be pass$ by record$ vote to reflect ! vote ( ea* memb] ( ,congress !reon4 7ii7 ,! provisions ( ?is p>agraph are enact$ by ,congress-- 7,i7 z an ex]cise ( ! rulemak+ p[] ( ! ,s5ate & ! ,h\se ( ,repres5tatives & z su* %all be consid]$ z "p ( ! rules ( ea* ,h\se ( ,congress1 & %all sup]s$e o!r rules only to ! ext5t t !y are inconsi/5t !re)2 & 7,,ii7 ) full recognition ( ! con/itutional "r ( ei!r ,h\se ( ,congress to *ange ! rules 7s f> z !y relate to ! proc$ures ( t ,h\se7 at any "t1 9 ! same mann]1 & to ! same ext5t z 9 ! case ( any o!r rule ( t ,h\se4 7,c7 ,dur+ ! #fj-;cal5d>-day p]iod beg9n+ on ! date on :i* ! ,secret>y submits ! report describ$ 9 p>agraph 7#b7 to ,congress1 x %all be 9 ord] z a matt] ( highe/ privilege 9 ea* ,h\se ( ,congress to consid] a bill or jo9t resolution1 if (f]$ by ! majority lead] ( su* ,h\se 7or a designee71 approv+ su* reque/ 9 its entirety4 7g7 ,limitations 7#a7 ,! waiv] provisions 9 subsection 7f7 %all n apply unless ! ,secret>y1 9 accordance ) ! requirem5ts 9 subsection 7f71 submits ! fir/ proposal = a pilot program n lat] ?an #ah mon?s aft] ! date ( ! enactm5t ( ! ,,va ,c>e 9 ! ,community ,act4 7#b7 ,not)/&+ section #ejb ( ?is title1 decisions by ! ,secret>y "u ?is section %all1 consi/5t ) section #eaa ( ?is title1 be f9al & conclusive & may n be review$ by any o!r (ficial or by any c\rt1 :e!r by an action 9 ! nature ( m&amus or o!rwise4 7#c7 7,a7 ,if ! ,secret>y det]m9es t ! pilot program is n improv+ ! quality ( c>e or produc+ co/ sav+s1 ! ,secret>y %all-- 7i7 propose a modification to ! pilot program 9 ! int]im report t %all also be consid]$ a report "u subsection 7f77#b77;,a7 & %all be subject to ! t]ms & conditions ( subsection 7f77#b72 or 7ii7 t]m9ate su* pilot program n lat] ?an #cj days aft] submitt+ ! int]im report to ,congress4 7,b7 ,if ! ,secret>y t]m9ates ! pilot program "u subp>agraph 7,a77ii71 = purposes ( clauses 7vi7 & 7vii7 ( subsection 7f77#b77;,a71 su* int]im report w also s]ve z ! f9al report = t pilot program4 7h7 ,evaluation & report+ requirem5ts 7#a7 ,! ,secret>y %all conduct an evaluation ( ea* model te/$1 :i* %all include1 at a m9imum1 an analysis (-- 7,a7 ! quality ( c>e furni%$ "u ! model1 includ+ ! measurem5t ( pati5t-level outcomes & pati5t-c5t]$ness crit]ia det]m9$ appropriate by ! ,secret>y2 & 7,b7 ! *anges 9 sp5d+ by reason ( t model4 7#b7 ,! ,secret>y %all make ! results ( ea* evaluation "u ?is subsection available to ! public 9 a timely fa%ion & may e/abli% requirem5ts = o!r entities p>ticipat+ 9 ! te/+ ( models "u ?is section to collect & report in=mation t ! ,secret>y det]m9es is necess>y to monitor & evaluate su* models4 7i7 ,coord9ation & consultation 7#a7 ,! ,secret>y %all consult ) ! ,"u ,secret>y = ,heal? & ! ,special ,m$ical ,advisory ,gr\p e/abli%$ pursuant to section #gcab ( ?is title 9 ! developm5t & implem5tation ( any pilot program op]at$ "u ?is section4 7#b7 ,9 c>ry+ out ! duties "u ?is section1 ! ,secret>y %all consult repres5tatives ( relevant ,f$]al ag5cies1 & cl9ical & analytical exp]ts ) exp]tise 9 m$ic9e & heal? c>e managem5t4 ,! ,secret>y %all use appropriate me*anisms to seek input f int]e/$ p>ties4 7j7 ,expansion ( successful pilot programs ,tak+ into acc\nt ! evaluation "u subsection 7f71 ! ,secret>y may1 ?r\gh rulemak+1 exp& 7includ+ implem5tation on a nationwide basis7 ! duration & ! scope ( a model t is be+ te/$ "u subsection 7a7 to ! ext5t det]m9$ appropriate by ! ,secret>y1 if-- 7#a7 ! ,secret>y det]m9es t su* expansion is expect$ to-- 7,a7 r$uce sp5d+ )\t r$uc+ ! quality ( c>e2 or 7,b7 improve ! quality ( pati5t c>e )\t increas+ sp5d+2 & 7#b7 ! ,secret>y det]m9es t su* expansion w\ld n d5y or limit ! cov]age or provision ( b5efits = individuals receiv+ b5efits "u ?is *apt]4 4 7b7 ,con=m+ am5dm5t ,! table ( sections at ! beg9n+ ( su* *apt]1 z am5d$ by section #aji1 is fur!r am5d$ by ins]t+ aft] ! item relat+ to section #agjc;,c ! foll[+ new item3 #agjc;,d4 ,c5t] = ,innovation = ,c>e & ,paym5t4 4 ,,iii ,improvem5ts to ,recruitm5t ( ,physicians #cja4 ,designat$ s*ol>%ips = physicians & d5ti/s "u ,dep>tm5t ( ,vet]ans ,affairs ,heal? ,pr(essional ,s*ol>%ip ,program 7a7 ,s*ol>%ips = physicians & d5ti/s ,section #gfab7;b7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#f7 7,a7 ,( ! s*ol>%ips aw>d$ "u ?is sub*apt]1 ! ,secret>y %all ensure t n less ?an #ej s*ol>%ips are aw>d$ ea* ye> to individuals :o are accept$ = enrollm5t or enroll$ 7z describ$ 9 section #gfjb ( ?is title7 9 a program ( education or tra9+ lead+ to employm5t z a physician or d5ti/ until su* date z ! ,secret>y det]m9es t ! /aff+ %ortage ( physicians & d5ti/s 9 ! ,dep>tm5t is less ?an #ejj4 7,b7 ,aft] su* date1 ! ,secret>y %all ensure t ( ! s*ol>%ips aw>d$ "u ?is sub*apt]1 a numb] ( s*ol>%ips is aw>d$ ea* ye> to individuals ref]r$ to 9 subp>agraph 7,a7 9 an am\nt equal to n less ?an t5 p]c5t ( ! /aff+ %ortage ( physicians & d5ti/s 9 ! ,dep>tm5t1 z det]m9$ by ! ,secret>y4 7,c7 ,not)/&+ subsection 7c77#a71 ! agreem5t betwe5 ! ,secret>y & a p>ticipant 9 ! ,s*ol>%ip ,program :o receives a s*ol>%ip pursuant to ?is p>agraph %all provide ! foll[+3 7i7 ,! ,secret>y's agreem5t to provide ! p>ticipant ) a s*ol>%ip "u ?is sub*apt] = a specifi$ numb] 7f two to f\r7 ( s*ool ye>s dur+ :i* ! p>ticipant is pursu+ a c\rse ( education or tra9+ lead+ to employm5t z a physician or d5ti/4 7ii7 ,! p>ticipant's agreem5t to s]ve z a full-"t employee 9 ! ,vet]ans ,heal? ,adm9i/ration = a p]iod ( "t 7h]e9aft] 9 ?is sub*apt] ref]r$ to z ! p]iod ( obligat$ s]vice7 ( #ah mon?s = ea* s*ool ye> or "p !re( = :i* ! p>ticipant 0 provid$ a s*ol>%ip "u ! ,s*ol>%ip ,program4 7,d7 ,9 provid+ s*ol>%ips pursuant to ?is p>agraph1 ! ,secret>y may provide a pref]5ce = applicants :o are vet]ans4 7,e7 ,on an annual basis1 ! ,secret>y %all provide to appropriate educational in/itutions in=mational mat]ial ab\t ! availability ( s*ol>%ips "u ?is p>agraph4 4 7b7 ,brea* ( agreem5t ,section #gfag7;b7 ( su* title is am5d$-- 7#a7 by r$esignat+ p>agraphs 7#d7 & 7#e7 z p>agraphs 7#e7 & 7#f71 respectively2 & 7#b7 by ins]t+ aft] p>agraph 7#c7 ! foll[+ new p>agraph 7#d73 7#d7 ,9 ! case ( a p>ticipant :o is enroll$ 9 a program or education or tra9+ lead+ to employm5t z a physician1 ! p>ticipant fails to successfully complete po/-graduate tra9+ lead+ to eligibility = bo>d c]tification 9 a specialty4 4 7c7 ,ext5sion ( program ,section #gfai ( su* title is am5d$ by /rik+ ,decemb] #ca1 #bjai & ins]t+ ,decemb] #ca1 #bjcc4 #cjb4 ,e/abli%m5t ( ,dep>tm5t ( ,vet]ans ,affairs ,specialty ,education ,loan ,repaym5t ,program 7a7 ,9 g5]al ,*apt] #gf ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ aft] sub*apt] ,,vii ! foll[+ new sub*apt]3 ,,viii ,specialty ,education ,loan ,repaym5t ,program #gfia4 ,e/abli%m5t ,z "p ( ! ,educational ,assi/ance ,program1 ! ,secret>y may c>ry out a /ud5t loan repaym5t program "u section #ecgi ( title #e4 ,! program %all be kn[n z ! ,dep>tm5t ( ,vet]ans ,affairs ,specialty ,education ,loan ,repaym5t ,program 79 ?is *apt] ref]r$ to z ! ,specialty ,education ,loan ,repaym5t ,program74 #gfib4 ,purpose ,! purpose ( ! ,specialty ,education ,loan ,repaym5t ,program is to assi/1 ?r\gh ! e/abli%m5t ( an inc5tive program = c]ta9 individuals employ$ 9 ! ,vet]ans ,heal? ,adm9i/ration1 9 meet+ ! /aff+ ne$s ( ! ,vet]ans ,heal? ,adm9i/ration = physicians 9 m$ical specialties = :i* ! ,secret>y det]m9es recruitm5t or ret5tion ( qualifi$ p]sonnel is difficult4 #gfic4 ,eligibility2 pref]5ce2 cov]$ co/s 7a7 ,eligibility ,an individual is eligible to p>ticipate 9 ! ,specialty ,education ,loan ,repaym5t ,program if ! individual-- 7#a7 is hir$ "u section #gdja ( ?is title to "w 9 an occupation describ$ 9 section #gfib ( ?is title2 7#b7 owes any am\nt ( pr9cipal or int]e/ "u a loan1 ! proce$s ( :i* 7 us$ by or on behalf ( t individual to pay co/s relat+ to a c\rse ( education or tra9+ :i* l$ to a degree t qualifi$ ! individual = ! position ref]r$ to 9 p>agraph 7#a72 & 7#c7 is-- 7,a7 rec5tly graduat$ f an accr$it$ m$ical or o/eopa?ic s*ool & mat*$ to an accr$it$ resid5cy program 9 a m$ical specialty describ$ 9 section #gfib ( ?is title2 or 7,b7 a physician 9 tra9+ 9 a m$ical specialty describ$ 9 section #gfib ( ?is title ) m ?an two ye>s rema9+ 9 su* tra9+4 7b7 ,pref]5ce = vet]ans ,9 select+ individuals = p>ticipation 9 ! ,specialty ,education ,loan ,repaym5t ,program "u ?is sub*apt]1 ! ,secret>y may give pref]5ce to vet]ans4 7c7 ,cov]$ co/s ,= purposes ( subsection 7a77#b71 co/s relat+ to a c\rse ( education or tra9+ include-- 7#a7 tuition exp5ses2 7#b7 all o!r reasonable educational exp5ses1 includ+ exp5ses = fees1 books1 equipm5t1 & laboratory exp5ses2 & 7#c7 reasonable liv+ exp5ses4 #gfid4 ,specialty education loan repaym5t 7a7 ,9 g5]al ,paym5ts "u ! ,specialty ,education ,loan ,repaym5t ,program %all consi/ ( paym5ts = ! pr9cipal & int]e/ on loans describ$ 9 section #gfhb7;a77#b7 ( ?is title = individuals select$ to p>ticipate 9 ! ,program to ! hold]s ( su* loans4 7b7 ,frequ5cy ( paym5t ,! ,secret>y %all make paym5ts = any giv5 p>ticipant 9 ! ,specialty ,education ,loan ,repaym5t ,program on a s*$ule det]m9$ appropriate by ! ,secret>y4 7c7 ,maximum am\nt2 waiv] 7#a7 ,! am\nt ( paym5ts made = a p>ticipant "u ! ,specialty ,education ,loan ,repaym5t ,program may n exce$ #afj1jjj ov] a total ( f\r ye>s ( p>ticipation 9 ! ,program1 ( :i* n m ?an #dj1jjj ( su* paym5ts may be made 9 ea* ye> ( p>ticipation 9 ! ,program4 7#b7 7,a7 ,! ,secret>y may waive ! limitations "u p>agraph 7#a7 9 ! case ( a p>ticipant describ$ 9 subp>agraph 7,b74 ,9 ! case ( su* a waiv]1 ! total am\nt ( paym5ts payable to or = t p>ticipant is ! total am\nt ( ! pr9cipal & ! int]e/ on ! p>ticipant's loans ref]r$ to 9 subsection 7a74 7,b7 ,a p>ticipant describ$ 9 ?is subp>agraph is a p>ticipant 9 ! ,program :o ! ,secret>y det]m9es s]ves 9 a position = :i* !re is a %ortage ( qualifi$ employees by reason ( ei!r ! location or ! requirem5ts ( ! position4 #gfie4 ,*oice ( location ,ea* p>ticipant 9 ! ,specialty ,education ,loan ,repaym5t ,program :o completes resid5cy may select1 f a li/ ( m$ical facilities ( ! ,vet]ans ,heal? ,adm9i/ration provid$ by ! ,secret>y1 at :i* su* facility ! p>ticipant w "w 9 a m$ical specialty describ$ 9 section #gfib ( ?is title4 #gfif4 ,t]m ( obligat$ s]vice 7a7 ,9 g5]al ,9 addition to any requirem5ts "u section #ecgi7;c7 ( title #e1 a p>ticipant 9 ! ,specialty ,education ,loan ,repaym5t ,program mu/ agree1 9 writ+ & be=e ! ,secret>y may make any paym5t to or = ! p>ticipant1 to-- 7#a7 obta9 a lic5se to practice m$ic9e 9 a ,/ate2 7#b7 successfully complete po/-graduate tra9+ lead+ to eligibility = bo>d c]tification 9 a specialty2 7#c7 s]ve z a full-"t cl9ical practice employee ( ! ,vet]ans ,heal? ,adm9i/ration = #ab mon?s = e #dj1jjj 9 su* b5efits t ! employee receives1 b 9 no case = few] ?an #bd mon?s2 & 7#d7 except z provid$ 9 subsection 7b71 to beg9 su* s]vice z a full-"t practice employee by n lat] ?an #fj days aft] complet+ a resid5cy4 7b7 ,fell[%ip ,9 ! case ( a p>ticipant :o receives an accr$it$ fell[%ip 9 a m$ical specialty o!r ?an a m$ical specialty describ$ 9 section #gfib ( ?is title1 ! ,secret>y1 on writt5 reque/ ( ! p>ticipant1 may delay ! t]m ( obligat$ s]vice "u subsection 7a7 = ! p>ticipant until aft] ! p>ticipant completes ! fell[%ip1 b 9 no case lat] ?an #fj days aft] completion ( su* fell[%ip4 7c7 ,p5alty 7#a7 ,an employee :o does n complete a p]iod ( obligat$ s]vice "u ?is section %all owe ! ,f$]al ,gov]nm5t an am\nt det]m9$ 9 accordance ) ! foll[+ =mula3 ,a,b77,t,s7,t774 7#b7 ,9 ! =mula 9 p>agraph 7#a73 7,a7 ,a is ! am\nt ! employee owes ! ,f$]al ,gov]nm5t4 7,b7 ,b is ! sum ( all paym5ts to or = ! p>ticipant "u ! ,specialty ,education ,loan ,repaym5t ,program4 7,c7 ,t is ! numb] ( mon?s 9 ! p]iod ( obligat$ s]vice ( ! employee4 7,d7 ,s is ! numb] ( :ole mon?s ( su* p]iod ( obligat$ s]vice s]v$ by ! employee4 #gfig4 ,relation%ip to ,educational ,assi/ance ,program ,assi/ance "u ! ,specialty ,education ,loan ,repaym5t ,program may be 9 addition to o!r assi/ance available to individuals "u ! ,educational ,assi/ance ,program4 4 7b7 ,con=m+ & te*nical am5dm5ts 7#a7 ,con=m+ am5dm5ts 7,a7 ,section #gfja7;a7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7i7 9 p>agraph 7#d71 by /rik+ &2 7ii7 9 p>agraph 7#e71 by /rik+ ! p]iod & ins]t+ 2 &2 & 7iii7 by add+ at ! end ! foll[+ new p>agraph3 7#f7 ! specialty education loan repaym5t program provid$ = 9 sub*apt] ,,viii ( ?is *apt]4 4 7,b7 ,section #gfjc7;a77#a7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ or ,,vi & ins]t+ ,,vi1 or ,,viii4 7,c7 ,section #gfjd ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by /rik+ or ,,vi ea* place x appe>s & ins]t+ ,,vi1 or ,,viii4 7,d7 ,section #gfca ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7i7 9 subsection 7a77#a7-- 7,i7 by /rik+ & aft] s*ol>%ip am\nt12 & 7,,ii7 by ins]t+ 1 & ! maximum specialty education loan repaym5t am\nt aft] r$uction paym5ts am\nt2 & 7ii7 9 subsection 7b7 by add+ at ! end ! foll[+ new p>agraph3 7#g7 ,! t]m specialty education loan repaym5t am\nt means ! maximum am\nt ( specialty education loan repaym5t paym5ts payable to or = a p>ticipant 9 ! ,dep>tm5t ( ,vet]ans ,affairs ,specialty ,education ,loan ,repaym5t ,program "u sub*apt] ,,viii ( ?is *apt]1 z specifi$ 9 section #gfid7;c77#a7 ( ?is title & z previ\sly adju/$ 7if at all7 9 accordance ) ?is section4 4 7,e7 ,section #gfcb ( title #ch1 ,unit$ ,/ates ,code1 is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ & ! ,education ,debt ,r$uction ,program & ins]t+ ! ,education ,debt ,r$uction ,program1 & ! ,specialty ,education ,loan ,repaym5t ,program2 & 7ii7 9 p>agraph 7#d71 by /rik+ & p] p>ticipant 9 ! ,education ,debt ,r$uction ,program & ins]t+ p] p>ticipant 9 ! ,education ,debt ,r$uction ,program1 & p] p>ticipant 9 ! ,specialty ,education ,loan ,repaym5t ,program4 7#b7 ,table ( sections ,! table ( sections at ! beg9n+ ( *apt] #gf ( su* title is am5d$ by ins]t+ aft] ! items relat+ to sub*apt] ,,vii ! foll[+3 ,sub*apt] ,,viii--,specialty ,education ,loan ,repaym5t ,program #gfia4 ,e/abli%m5t4 #gfib4 ,purpose4 #gfic4 ,eligibility2 pref]5ce2 cov]$ co/s4 #gfid4 ,specialty education loan repaym5t4 #gfie4 ,*oice ( location4 #gfif4 ,t]m ( obligat$ s]vice4 #gfig4 ,relation%ip to ,educational ,assi/ance ,program4 4 7c7 ,ne$s ( ! ,,vha ,9 mak+ det]m9ations ea* ye> "u section #gfib ( title #ch1 ,unit$ ,/ates ,code1 z enact$ by subsection 7a71 ! ,secret>y ( ,vet]ans ,affairs %all consid] ! anticipat$ ne$s ( ! ,vet]ans ,heal? ,adm9i/ration dur+ ! p]iod two to six ye>s 9 ! future4 7d7 ,(f] deadl9e ,9 ! case ( an applicant :o applies be=e receiv+ a resid5cy mat* & :om ! ,secret>y ( ,vet]ans ,affairs selects = p>ticipation 9 ! ,specialty ,education ,loan ,repaym5t ,program e/abli%$ by subsection 7a71 ! ,secret>y %all (f] p>ticipation to ! applicant n lat] ?an #bh days aft]-- 7#a7 ! applicant mat*es ) a resid5cy 9 a m$ical specialty describ$ 9 section #gfib ( title #ch1 ,unit$ ,/ates ,code1 z enact$ by subsection 7a72 & 7#b7 su* mat* is publi%$4 7e7 ,publicity ,! ,secret>y ( ,vet]ans ,affairs %all take su* /eps z ! ,secret>y det]m9es are appropriate to publicize ! ,specialty ,education ,loan ,repaym5t ,program e/abli%$ "u sub*apt] ,,viii ( *apt] #gf ( title #ch1 ,unit$ ,/ates ,code1 z enact$ by subsection 7a74 #cjc4 ,vet]ans heal+ vet]ans m$ical access & s*ol>%ip program 7a7 ,e/abli%m5t ,! ,secret>y ( ,vet]ans ,affairs1 act+ ?r\gh ! ,(fice ( ,academic ,affiliations ( ! ,dep>tm5t ( ,vet]ans ,affairs1 %all c>ry out a pilot program "u :i* ! ,secret>y %all provide fund+ = ! m$ical education ( a total ( #ah eligible vet]ans4 ,su* fund+ %all be provid$ = two vet]ans enroll$ 9 ea* cov]$ m$ical s*ools 9 accordance ) ?is section4 7b7 ,eligible vet]ans ,to be eligible to receive fund+ = m$ical education "u ?is section1 a vet]an %all-- 7#a7 h be5 dis*>g$ f ! ,arm$ ,=ces n m ?an t5 ye>s be=e ! date ( application = admission to a cov]$ m$ical s*ool2 7#b7 n be entitl$ to educational assi/ance "u *apt] #cj1 #ca1 #cb1 #cc1 #cd1 or #ce ( title #ch1 ,unit$ ,/ates ,code1 or *apt] #afjf or #afjg ( title #aj1 ,unit$ ,/ates ,code2 7#c7 apply = admission to a cov]$ m$ical s*ool = ! ent]+ class ( #bjai2 7#d7 indicate on su* application = admission t ! vet]an w\ld l to be consid]$ = an aw>d ( fund+ "u ?is section2 7#e7 meet ! m9imum admissions crit]ia = ! cov]$ m$ical s*ool to :i* ! vet]an applies2 & 7#f7 ent] into an agreem5t describ$ 9 subsection 7e74 7c7 ,aw>d ( fund+ 7#a7 ,9 g5]al ,ea* cov]$ m$ical s*ool t opts to p>ticipate 9 ! program "u ?is section %all res]ve two seats 9 ! ent]+ class ( #bjai = eligible vet]ans :o receive fund+ "u su* program4 ,su* fund+ %all be aw>d$ to ! two eligible vet]ans ) ! highe/ admissions rank+s = su* class at su* s*ool4 7#b7 ,am\nt ( fund+ ,ea* eligible vet]an :o receives fund+ "u ?is section %all receive an am\nt equal to ! actual co/ (-- 7,a7 tuition at ! cov]$ m$ical s*ool at :i* ! vet]an enrolls = f\r ye>s2 7,b7 books1 fees1 & te*nical equipm5t2 7,c7 fees associat$ ) ! ,national ,resid5cy ,mat* ,program2 7,d7 two away rotations p]=m$ dur+ ! f\r? ye> at a ,dep>tm5t ( ,vet]ans ,affairs m$ical facility2 & 7,e7 a mon?ly /ip5d = ! f\r-ye> p]iod dur+ :i* ! vet]an is enroll$ 9 m$ical s*ool 9 an am\nt to be det]m9$ by ! ,secret>y4 7#c7 ,di/ribution ( fund+ ,9 ! ev5t t two or m eligible vet]ans d n apply = admission at "o ( ! cov]$ m$ical s*ools = ! ent]+ class ( #bjai1 ! ,secret>y %all di/ribute ! available fund+ to eligible vet]ans :o appli$ = admission at o!r cov]$ m$ical s*ools4 7d7 ,agreem5t 7#a7 ,t]ms ( agreem5t ,ea* eligible vet]an :o accepts fund+ = m$ical education "u ?is section %all ent] into an agreem5t ) ! ,secret>y t provides t ! vet]an agrees-- 7,a7 to ma9ta9 enrollm5t & att5dance 9 ! m$ical s*ool2 7,b7 :ile enroll$ 9 su* m$ical s*ool1 to ma9ta9 an acceptable level ( academic /&+ 7z det]m9$ by ! m$ical s*ool "u regulations prescrib$ by ! ,secret>y72 7,c7 to complete po/-graduate tra9+ lead+ to eligibility = bo>d c]tification 9 a speciality applicable to ! ,dep>tm5t ( ,vet]ans ,affairs1 z det]m9$ by ! ,secret>y2 7,d7 aft] completion ( m$ical s*ool1 to obta9 a lic5se to practice m$ic9e 9 a ,/ate2 & 7,e7 aft] completion ( m$ical s*ool & po/-graduate tra9+1 to s]ve z a full-"t cl9ical practice employee 9 ! ,vet]ans ,heal? ,adm9i/ration = a p]iod ( f\r ye>s4 7#b7 ,brea* ( agreem5t ,if an eligible vet]an :o accepts fund+ "u ?is section brea*es ! t]ms ( ! agreem5t describ$ 9 p>agraph 7#a71 ! ,unit$ ,/ates %all be entitl$ to recov] damages 9 an am\nt equal to ! total am\nt ( su* fund+ receiv$ by ! vet]an4 7e7 ,rule ( con/ruction ,no?+ 9 ?is section %all be con/ru$ to prev5t any cov]$ m$ical s*ool f accept+ m ?an two eligible vet]ans = ! ent]+ class ( #bjai4 7f7 ,report to ,congress ,n lat] ?an ,decemb] #ca1 #bjbj1 & annually !reaft] = ! subsequ5t ?ree ye>s1 ! ,secret>y %all submit to ,congress a report on ! pilot program "u ?is section4 ,su* report %all include ! evaluation ( ! ,secret>y ( ! success ( ! pilot program1 includ+ ! numb] ( vet]ans :o receiv$ fund+ "u ! program :o matriculat$ & an evaluation ( ! academic progress ( su* vet]ans4 7g7 ,cov]$ m$ical s*ools ,9 ?is section1 ! t]m cov]$ m$ical s*ool means any ( ! foll[+4 7#a7 ,! ,teague-,cran/on m$ical s*ools1 consi/+ (-- 7,a7 ,texas ,a,m ,college ( ,m$ic9e2 7,b7 ,quill5 ,college ( ,m$ic9e at ,ea/ ,t5nessee ,/ate ,univ]sity2 7,c7 ,boon%(t ,s*ool ( ,m$ic9e at ,wright ,/ate ,univ]sity2 7,d7 ,joan ,c4 ,edw>ds ,s*ool ( ,m$ic9e at ,m>%all ,univ]sity2 & 7,e7 ,univ]sity ( ,s\? ,c>ol9a ,s*ool ( ,m$ic9e4 7#b7 ,*>les ,r ,drew ,univ]sity ( ,m$ic9e & ,sci5ce4 7#c7 ,h[>d ,univ]sity ,college ( ,m$ic9e4 7#d7 ,meh>ry ,m$ical ,college4 7#e7 ,moreh\se ,s*ool ( ,m$ic9e4 ,m>* #e1 #bjah,report$ ) an am5dm5t1 committ$ to ! ,committee ( ! ,:ole ,h\se on ! ,/ate ( ! ,union1 & ord]$ to be pr9t$