,,ii  #aaeth ,,congress  #ast ,session  
,s4 #abgi  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #be1 #bjag
 ,mr4 ,crapo introduced the following   
bill2 which was read twice and referred 
to the ,committee on ,veterans' ,affairs
  ,a ,,bill  ,to amend title #ch1       
,united ,states ,code1 to furnish health
 care from the ,department of ,veterans 
,affairs through the use of             
non-,department health care providers1  
and for other purposes4  #a4 ,short     
title2 table of contents  7a7 ,short    
title  ,this ,act may be cited as the   
,veterans ,health ,administration       
,reform ,act of #bjag4  7b7 ,table of   
contents ,the table of contents for this
 ,act is as follows3 ,sec4 #a4 ,short   
title2 table of contents4 ,sec4 #b4     
,establishment of ,care in the          
,community ,program4 ,sec4 #c4          
,authorization of provider agreements   
under ,care in the ,community ,program4 
,sec4 #d4 ,expansion of reimbursement of
 veterans for emergency treatment and   

urgent care4 ,sec4 #e4 ,memorandum of   
understanding between ,department of    
,veterans ,affairs and ,centers for     
,medicare  ,medicaid ,services4 ,sec4   
#f4 ,education program on health care   
options from ,department of ,veterans   
,affairs4 ,sec4 #g4 ,training program   
for administration of ,non-,department  
of ,veterans ,affairs health care4 ,sec4
 #h4 ,analysis of electronic health     
record of ,department of ,veterans      
,affairs4 ,sec4 #i4 ,reports assessing  
effectiveness of certain positions and  
offices of ,department of ,veterans     
,affairs4 ,sec4 #aj4 ,sense of ,congress
 regarding reforms at the ,veterans     
,health ,administration4  #b4           
,establishment of ,care in the          
,community ,program  7a7 ,establishment 
of program  7#a7 ,in general ,section   
#agjc of title #ch1 ,united ,states     
,code1 is amended to read as follows3   
#agjc4 ,care in the ,community ,program 
7a7 ,in general  7#a7 ,the ,secretary   
may furnish care and services described 

in subsection 7c7 to eligible veterans  
described in subsection 7b7 from        
non-,department health care providers   
through the use of ,veterans ,care      
,agreements under section #agjc;,a of   
this title1 arrangements under          
subsection 7d71 or under any other law  
administered by the ,secretary4 ,the    
furnishing of care and services under   
this section may be referred to as the  
,care in the ,community ,program4  7#b7 
,for purposes of this section1 care or  
services furnished by the ,secretary    
means that the ,secretary authorizes the
 care or services and pays for the care 
or services4  7#c7 ,an eligible veteran 
may elect to decline to receive care or 
services furnished under this section   
and instead receive such care or        
services at a medical facility of the   
,department4  7b7 ,eligible veterans    
7#a7 ,a veteran is an eligible veteran  
for purposes of this section if the     
veteran is enrolled in the system of    
annual patient enrollment established   

and operated under section #agje of this
 title and one or more of the following 
conditions apply3  7,a7 ,the ,secretary 
determines that it is in the clinical   
best interest of the veteran to access  
care or services outside of the         
,department4  7,b7 ,the veteran would   
experience an undue burden if the       
veteran seeks care or services from the 
,department4  7,c7 ,it is not economical
 for the ,department to provide the     
veteran the care or services that the   
veteran needs4  7#b7 ,a determination by
 the ,secretary under paragraph         
7#a77;,a7 shall include an assessment of
 factors relating to the medical or     
clinical condition of the veteran and   
the timeliness of the ,department in    
providing the care or services required 
by the veteran4  7#c7 ,for purposes of  
paragraph 7#a77;,b71 an undue burden--  
7,a7 means--  7i7 an excessive driving  
distance1 geographical challenges1 or   
environmental factors impede the access 
of the veteran to care or services from 

the ,department2 or  7ii7 the care or   
services sought by the veteran are not  
provided by a medical facility of the   
,department that is reasonably          
accessible to the veteran2 and  7,b7 may
 include other circumstances as         
determined by the ,secretary upon       
assessing-- 7i7 the nature or complexity
 of the care or services that the       
veteran requires2  7ii7 the frequency   
with which the veteran requires such    
care or services2 and  7iii7 the need   
for an attendant to provide required aid
 or physical assistance to the veteran  
for the veteran to travel to a medical  
facility of the ,department4  7c7 ,care 
and services described ,care and        
services described in this subsection   
are the following3 7#a7 ,hospital care4 
7#b7 ,medical services4  7#c7           
,diagnostic care4  7#d7 ,with respect to
 veterans described in section          
#agab7;a77#a77;,f7 of this title1       
outpatient dental services and treatment
 and related dental appliances4  7#e7   

,such other care or services as         
determined by the ,secretary4  7d7      
,arrangements  7#a7 ,the ,secretary may 
provide care and services under this    
section through arrangements described  
in paragraph 7#b74  7#b7 ,arrangements  
described in this paragraph are the     
following3 7,a7 ,health care            
coordination and sharing activities with
 the ,department of ,defense under      
section #haaa of this title4  7,b7      
,arrangements under section #haec of    
this title4  7,c7 ,arrangements between 
the ,secretary and the ,director of the 
,indian ,health ,service4  7,d7         
,agreements under section #agde of this 
title4  7,e7 ,agreements with           
,federally-qualified health centers 7as 
defined in section #aije7l77#b77;,b7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif;d7l77#b77;,b7774  7#c7  
,nothing in this section may be         
construed to modify the way the         
,department1 other ,federal agencies1   
and ,states determine responsibility for

 payment under arrangements described in
 paragraph 7#b74  7e7 ,prohibition on   
collection of payment ,a health care    
provider that provides care or services 
under this section shall agree not to   
recover or collect payment from--  7#a7 
an eligible veteran in connection with  
care or services furnished under this   
section2 or  7#b7 a health-plan contract
 or other third party on behalf of the  
eligible veteran in connection with such
 care or services4  7f7 ,electronic     
waiting list for care at ,department    
facilities  7#a7 ,if an eligible veteran
 seeks care or services under this      
section1 the ,secretary shall provide   
the veteran an opportunity to be        
included on an electronic waiting list  
maintained by the ,department for an    
appointment for care or services        
described in subsection 7c7 at a medical
 facility of the ,department4  7#b7 ,the
 electronic waiting list maintained     
under paragraph 7#a7 shall allow access 
by each eligible veteran via            

www4myhealth4va4gov or any successor    
website 7or other digital channel7 for  
the following purposes3  7,a7 ,to       
determine the place of such eligible    
veteran on the waiting list4  7,b7 ,to  
determine the average length of time an 
individual spends on the waiting list1  
disaggregated by medical facility of the
 ,department and type of care or service
 needed1 for purposes of allowing such  
eligible veteran to make an informed    
election to receive care or services    
under this section or at a medical      
facility of the ,department4  7g7       
,information on availability of care    
,the ,secretary shall provide           
information to a veteran about the      
availability of care and services under 
this section in the following           
circumstances3  7#a7 ,when the veteran  
enrolls in the system of annual patient 
enrollment established and operated     
under section #agje of this title4  7#b7
 ,when the veteran attempts to schedule 
an appointment for the receipt of care  

or services described in subsection 7c7 
from the ,department but is unable to   
schedule an appointment within the      
wait-time goals of the ,veterans ,health
 ,administration for the furnishing of  
such care or services4  7#c7 ,when the  
veteran becomes eligible for care or    
services under this section under       
subparagraph 7,a71 7,b71 or 7,c7 of     
subsection 7b77#a74  7h7 ,follow-,up    
care ,in carrying out this section1 the 
,secretary shall ensure that1 at the    
election of an eligible veteran who     
receives care or services from a health 
care provider in an episode of care     
under this section1 the veteran receives
 such care or services from such health 
care provider through the completion of 
the episode of care 7but for a period   
not exceeding one year71 including all  
specialty and ancillary services deemed 
necessary as part of the treatment      
recommended in the course of such care  
or services4  7i7 ,cost sharing  7#a7   
,the ,secretary shall require an        

eligible veteran to pay a copayment for 
the receipt of care or services under   
this section only if such eligible      
veteran would be required to pay a      
copayment for the receipt of such care  
or services at a medical facility of the
 ,department or from a health care      
provider of the ,department4  7#b7 ,the 
amount of a copayment charged under     
paragraph 7#a7 may not exceed the amount
 of the copayment that would be payable 
by such eligible veteran for the receipt
 of such care or services at a medical  
facility of the ,department or from a   
health care provider of the ,department4
  7j7 ,administration of program  7#a7  
,the ,non-,,va ,care ,coordination      
,program of the ,department1 working    
jointly with the ,chief ,business       
,office of the ,department1 shall       
administer the ,care in the ,community  
,program under this section4  7#b7      
,administration of the ,care in the     
,community ,program shall include the   
following3 7,a7 ,ensuring that an       

eligible veteran receives an appointment
 for care or services under this section
 within--  7i7 the wait-time goals of   
the ,veterans ,health ,administration2  
or  7ii7 the period that a health care  
provider of the veteran at the          
,department determines the care or      
services are needed4  7,b7 ,ensuring    
that the ,secretary1 including any      
contractors of the ,secretary1 pay      
health care providers on time4  7,c7    
,ensuring that medical information of an
 eligible veteran who receives care or  
services under this section is sent to  
the health care provider of the veteran 
at the ,department4  7,d7 ,ensuring that
 the ,secretary has information         
regarding any other health insurance of 
an eligible veteran4  7#c7 ,the         
,secretary shall ensure that the        
,non-,,va ,care ,coordination ,program  
of the ,department and the ,chief       
,business ,office of the ,department are
 working together effectively and       
efficiently throughout the process of   

furnishing care under this section4     
7#d7 ,the ,secretary shall notify the   
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives if any functions under 
this subsection require alteration or   
realignment4  7k7 ,payment of claims    
7#a7 ,the ,secretary shall ensure that  
all payments of claims under this       
section comply with chapter #ci of title
 #ca 7commonly referred to as the       
,prompt ,payment ,act7 and the          
requirements of this subsection4 ,if    
there is a conflict between the         
requirements of the ,prompt ,payment    
,act and the requirements of this       
subsection1 the ,secretary shall comply 
with the requirements of this           
subsection4  7#b7 7,a7 ,payment by the  
,secretary of claims under this section 
shall be issued1 mailed1 or otherwise   
transmitted with respect to not less    
than #ie percent of all such claims     
within #cj days after the date on which 

the claim is received1 if--  7i7 the    
claim is a clean claim2 and  7ii7 the   
claim is not one for which payment is   
made on a periodic interim payment      
basis4  7,b7 ,in this paragraph1 the    
term clean claim means a claim that has 
no defect or impropriety 7including any 
lack of any required substantiating     
documentation7 or particular            
circumstance requiring special treatment
 that prevents timely payment from being
 made on the claim under this section4  
7#c7 7,a7 ,the ,secretary is the primary
 payer for all care or services         
furnished under this section4  7,b7 ,the
 ,secretary may recover or collect      
reasonable charges for care or services 
furnished under this section from a     
third party pursuant to section #agbi of
 this title or any other provision of   
law that would permit the ,secretary to 
recover or collect the cost of care     
furnished at a facility of the          
,department or under the laws           
administered by the ,secretary4  7l7    

,online portal ,the ,secretary shall    
establish an online portal that health  
care providers participating in the     
,care in the ,community ,program may use
 as follows3  7#a7 ,to submit medical   
information with respect to eligible    
veterans furnished care or services     
under this section4  7#b7 ,to file      
claims for payment for care or services 
furnished under this section4  7#c7 ,to 
monitor the status of payment of claims 
under this section1 including whether or
 not the claim was approved or rejected4
  7#d7 ,to determine whether the        
,secretary requires additional          
information before processing the claim4
  7m7 ,annual report on contract care   
7#a7 ,not later than ,april #a each     
year1 the ,secretary shall submit to the
 ,committee on ,veterans' ,affairs of   
the ,senate and the ,committee on       
,veterans' ,affairs of the ,house of    
,representatives a report on health care
 contracted for under the laws          
administered by the ,secretary1         

including under the ,care in the        
,community ,program4  7#b7 ,each report 
submitted under paragraph 7#a7 shall--  
7,a7 describe the use by the ,secretary 
of ,veterans ,care ,agreements under    
section #agjc;,a of this title1         
arrangements under subsection 7e71 and  
other contracts or agreements for health
 care under this section or any other   
law administered by the ,secretary2     
7,b7 state the number of such           
agreements1 arrangements1 or contracts  
entered into and the costs of such      
agreements1 arrangements1 or contracts1 
disaggregated by medical center of the  
,department2 and  7,c7 include an       
assessment by the ,central ,office of   
the ,veterans ,health ,administration of
 the efforts of such office to          
coordinate such agreements1             
arrangements1 or contracts4  7n7 ,rule  
of construction ,nothing in this section
 or section #agjc;,a of this title shall
 be construed to prevent the ,secretary 
from entering into regional or national 

contracts to provide prescription       
medication1 dialysis treatment1         
prosthetics1 and such other care or     
services under this section as the      
,secretary considers appropriate4  4    
7#b7 ,clerical amendment ,the table of  
sections at the beginning of chapter #ag
 of such title is amended by striking   
the item related to section #agjc and   
inserting the following new item3       
#agjc4 ,care in the ,community ,program4
  4  7#c7 ,report on development and    
implementation of online portal  7,a7   
,in general ,not later than ,december   
#ca1 #bjag1 the ,under ,secretary for   
,health of the ,department of ,veterans 
,affairs shall submit to ,congress a    
report on the development and           
implementation by the ,department of    
,veterans ,affairs of the online portal 
established under subsection 7m7 of     
section #agjc of title #ch1 ,united     
,states ,code1 as added by paragraph    
7#a71 for the processing of claims by   
health care providers under the ,care in

 the ,community ,program under such     
section4  7,b7 ,elements ,the report    
required by subparagraph 7,a7 shall     
include the following3 7i7 ,a detailed  
schedule for developing and implementing
 the online portal described in         
subparagraph 7,a74  7ii7 ,an assessment 
of whether the online portal includes   
the following elements3 7,i7 ,automatic 
adjudication of claims4  7,,ii7         
,automated entry of authorizations for  
care or services4  7,,iii7 ,a mechanism 
by which health care providers can      
electronically submit medical records1  
including health care providers that a  
veteran may have seen without           
authorization from the ,department4     
7,,iv7 ,a web-based portal for health   
care providers to check the status of   
their claims4  7iii7 ,estimated costs   
for developing and implementing each    
aspect of the online portal4  7iv7      
,performance goals1 measures1 and       
interim milestones that the ,under      
,secretary for ,health will use to      

evaluate progress1 hold staff           
accountable for achieving desired       
results1 and report to stakeholders on  
the impact of the online portal in      
modernizing the claims processing system
 of the ,department4  7b7 ,conforming   
amendments  7#a7 ,dental care ,section  
#agab7;a77#c7 of title #ch1 ,united     
,states ,code1 is amended1 in paragraph 
7#c71 by striking under clause 7#a71    
7#b71 or 7#e7 of section #agjc7;a7 of   
this title and inserting under section  
#agjc of this title4  7#b7 ,readjustment
 counseling ,section #agab;,a7e77#a7 of 
such title is amended by striking       
sections #agjc7;a77#b7 and              
#agaj7;a77#a77;,b7 of this title and    
inserting sections #agjc and            
#agaj7;a77#a77;,b7 of this title4  7#c7 
,conforming repeal of superseded        
authority  7,a7 ,in general ,section    
#aja of the ,veterans ,access1 ,choice1 
and ,accountability ,act of #bjad       
7,public ,law #aac-adf2 #ch ,u4,s4,c4   
#agja note7 is repealed4  7,b7          

,conforming amendment ,section #bjh of  
such ,act is amended-- 7i7 in paragraph 
7#a71 by striking hospital care and     
medical services under section #aja and 
inserting care and services under       
section #agjc of title #ch1 ,united     
,states ,code2 and  7ii7 in paragraph   
7#b71 by striking hospital care and     
medical services and inserting care and 
services4  7c7 ,repeal of authority ,to 
contract for scarce medical specialists 
7#a7 ,in general ,section #gdji of title
 #ch1 ,united ,states ,code1 is         
repealed4  7#b7 ,clerical amendment ,the
 table of sections at the beginning of  
chapter #gd of such title is amended by 
striking the item relating to section   
#gdji4  #c4 ,authorization of provider  
agreements under ,care in the ,community
 ,program  7a7 ,in general ,subchapter  
,i of chapter #ag of title #ch1 ,united 
,states ,code1 is amended by inserting  
after section #agjc the following new   
section3  #agjc;,a4 ,care in the        
,community ,program3 provider agreements

  7a7 ,agreements ,to ,furnish ,care    
,the ,secretary may furnish care and    
services under the ,care in the         
,community ,program under section #agjc 
of this title by entering into          
agreements under this section with      
eligible providers that are certified   
under subsection 7c74  7b7 ,eligible    
providers ,for purposes of this section1
 an eligible provider is one of the     
following3 7#a7 ,a provider of services 
that has enrolled and entered into a    
provider agreement under section        
#ahff7;a7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #acie;cc7a774  7#b7 ,a   
physician or supplier that has enrolled 
and entered into a participation        
agreement under section #ahdb7;h7 of    
such ,act 7#db ,u4,s4,c4 #acieu7h774    
7#c7 ,a provider of items and services  
receiving payment under a ,state plan   
under title ,,xix of such ,act 7#db     
,u4,s4,c4 #acif et seq47 or a waiver of 
such a plan4  7#d7 ,a provider that is--
 7,a7 an ,aging and ,disability         

,resource ,center1 an area agency on    
aging1 or a ,state agency 7as defined in
 section #ajb of the ,older ,americans  
,act of #aife 7#db ,u4,s4,c4 #cjjb772 or
  7,b7 a center for independent living  
7as defined in section #gjb of the      
,rehabilitation ,act of #aigc 7#bi      
,u4,s4,c4 #gif;a774  7#e7 ,such other   
health care providers as the ,secretary 
considers appropriate for purposes of   
this section4  7c7 ,certification of    
eligible providers ,the ,secretary shall
 establish a process for the            
certification of eligible providers     
under this section4  7d7 ,rates for care
 and services  7#a7 ,except as otherwise
 provided in this subsection1 an        
eligible provider that enters into an   
agreement under this section to provide 
care or services under section #agjc of 
this title shall agree to accept as     
payment in full for such care or        
services an amount equal to the rate    
paid by the ,united ,states to a        
provider of services 7as defined in     

section #ahfa7u7 of the ,social         
,security ,act 7#db ,u4,s4,c4           
#aciex7u777 or a supplier 7as defined in
 section #ahfa7;d7 of such ,act 7#db    
,u4,s4,c4 #aciex7d777 under the         
,medicare program under title ,,xviii of
 the ,social ,security ,act 7#db        
,u4,s4,c4 #acie et seq47 for the same   
care or services4  7#b7 7,a7 ,a higher  
rate than the rate paid by the ,united  
,states as described in paragraph 7#a7  
may be negotiated with respect to the   
furnishing of care or services to a     
veteran who resides in a highly rural   
area4  7,b7 ,in this paragraph1 the term
 highly rural area means an area located
 in a county that has fewer than seven  
individuals residing in that county per 
square mile4  7#c7 ,with respect to     
furnishing care or services under this  
subsection in ,alaska1 the ,alaska ,fee 
,schedule of the ,department of         
,veterans ,affairs shall be followed1   
except for when another payment         
agreement1 including a contract or      

provider agreement1 is in place4  7#d7  
,with respect to furnishing care or     
services under this subsection in a     
,state with an ,all-,payer ,model       
,agreement under section #ahad7;b77#c7  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #acie;f7b77#c77 that became   
effective on ,january #a1 #bjad1 the    
,medicare payment rates under           
subparagraph 7,a7 shall be calculated   
based on the payment rates under such   
agreement4  7#e7 ,with respect to       
furnishing care or services under this  
subsection for which there is not a rate
 paid under the ,medicare program as    
described in paragraph 7#a71 such as    
dental care1 obstetrics and gynecology1 
and other services1 the rate paid for   
such care or services shall be          
determined by the ,secretary4  7#f7 ,in 
determining rates and making payments   
under this subsection1 the ,secretary   
may conduct pilot programs on           
alternative payment systems similar to  
those used under the ,medicare program1 

including the ,merit-based ,incentive   
,payment ,system under section #ahdh7q7 
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciew-#d7q77 and alternative 
payment models 7as defined in section   
#ahcc7z77#c77;,c7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#aciel7z77#c77;,c7774  7#g7 ,if a higher
 rate than the rate specified in        
paragraph 7#a7 is determined under this 
subsection1 the ,secretary shall notify 
the ,centers for ,medicare  ,medicaid   
,services regarding such higher rate4   
7e7 ,treatment of certain laws  7#a7 ,an
 agreement under this section may be    
entered into without regard to any      
contracting law that would require the  
,secretary to use competitive procedures
 in selecting the party with which to   
enter into the agreement4  7#b7 7,a7    
,except as provided in subparagraph 7,b7
 and unless otherwise provided in this  
section or regulations prescribed       
pursuant to this section1 an eligible   
provider that enters into an agreement  

under this section is not subject to1 in
 the carrying out of the agreement1 any 
contracting law that an eligible        
provider described in subsection        
7b77#a71 7b77#b71 or 7b77#c7 is not     
subject to under the original ,medicare 
fee-for-service program under parts ,a  
and ,b of title ,,xviii of the ,social  
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 or the ,medicaid program under    
title ,,xix of such ,act 7#db ,u4,s4,c4 
#acif et seq474  7,b7 ,the exclusion    
under subparagraph 7,a7 does not apply  
to laws regarding integrity1 ethics1    
fraud1 or that subject a person to civil
 or criminal penalties4  7#c7 ,title    
,,vii of the ,civil ,rights ,act of     
#aifd 7#db ,u4,s4,c4 #bjjj;e et seq47   
shall apply with respect to an eligible 
provider that enters into an agreement  
under this section to the same extent as
 such title applies with respect to the 
eligible provider in providing care or  
services through an agreement or        
arrangement other than under this       

section4  4  7b7 ,clerical amendment    
,the table of sections at the beginning 
of chapter #ag of such title is amended 
by inserting after the item related to  
section #agjc the following new item3   
#agjc;,a4 ,care in the ,community       
,program3 provider agreements4  4  #d4  
,expansion of reimbursement of veterans 
for emergency treatment and urgent care 
7a7 ,in general ,section #agbe of title 
#ch1 ,united ,states ,code1 is amended  
to read as follows3  #agbe4             
,reimbursement for emergency treatment  
and urgent care  7a7 ,in general  7#a7  
,subject to the provisions of this      
section1 the ,secretary shall reimburse 
a veteran described in subsection 7b7   
for the reasonable value of emergency   
treatment or urgent care furnished the  
veteran in a non-,department facility4  
7#b7 ,in any case in which reimbursement
 of a veteran is authorized under       
paragraph 7#a71 the ,secretary may1 in  
lieu of reimbursing the veteran1 make   
payment of the reasonable value of the  

furnished emergency treatment or urgent 
care directly--  7,a7 to the hospital or
 other health care provider that        
furnished the treatment or care2 or     
7,b7 to the person or organization that 
paid for such treatment or care on      
behalf of the veteran4  7b7 ,eligibility
 ,a veteran described in this subsection
 is an individual who-- 7#a7 is enrolled
 in the patient enrollment system of the
 ,department established and operated   
under section #agje of this title2 and  
7#b7 has received care under this       
chapter during the #bd-month period     
preceding the furnishing of the         
emergency treatment or urgent care for  
which reimbursement is sought under this
 section4  7c7 ,emergency transportation
 ,notwithstanding section #aaa of this  
title1 reimbursement of emergency       
treatment or urgent care under this     
section shall include reimbursement for 
the reasonable value of emergency       
transportation4  7d7 ,responsibility for
 payment ,the ,secretary shall be       

primarily responsible for reimbursing or
 otherwise paying the reasonable value  
of emergency treatment or urgent care   
under this section4  7e7 ,limitations on
 payment  7#a7 ,the ,secretary1 in      
accordance with regulations prescribed  
by the ,secretary for purposes of this  
section1 shall--  7,a7 establish the    
maximum amount payable under subsection 
7a72 and  7,b7 delineate the            
circumstances under which such payments 
may be made1 including such requirements
 on requesting reimbursement as the     
,secretary may establish4  7#b7 7,a7    
,payment by the ,secretary under this   
section on behalf of a veteran to a     
provider of emergency treatment or      
urgent care shall1 unless rejected and  
refunded by the provider within #cj days
 of receipt--  7i7 constitute payment in
 full for the emergency treatment or    
urgent care provided2 and  7ii7         
extinguish any liability on the part of 
the veteran for that treatment or care4 
7,b7 ,neither the absence of a contract 

or agreement between the ,secretary and 
a provider of emergency treatment or    
urgent care nor any provision of a      
contract1 agreement1 or assignment to   
the contrary shall operate to modify1   
limit1 or negate the requirements of    
subparagraph 7,a74  7,c7 ,a provider of 
emergency treatment or urgent care may  
not seek to recover from any third party
 the cost of emergency treatment or     
urgent care for which the provider has  
received payment from the ,secretary    
under this section4  7f7 ,recovery ,the 
,united ,states has the right to recover
 or collect reasonable charges for      
emergency treatment or urgent care      
furnished under this section in         
accordance with the provisions of       
section #agbi of this title4  7g7 ,cost 
sharing  7#a7 ,the ,secretary shall     
require a veteran to pay a copayment for
 the receipt of emergency treatment or  
urgent care under this section only if  
such veteran would be required to pay a 
copayment for the receipt of such       

treatment or care at a medical facility 
of the ,department or from a health care
 provider of the ,department4  7#b7 ,the
 amount of a copayment charged to a     
veteran under paragraph 7#a7 may not    
exceed the amount of the copayment that 
would be payable by such veteran for the
 receipt of emergency treatment or      
urgent care at a medical facility of the
 ,department or from a health care      
provider of the ,department4  7h7       
,definitions ,in this section3 7#a7 ,the
 term emergency treatment means medical 
care or services furnished1 in the      
judgment of the ,secretary--  7,a7 when 
such care or services are rendered in a 
medical emergency of such nature that a 
prudent layperson reasonably expects    
that delay in seeking immediate medical 
attention would be hazardous to life or 
health2 and  7,b7 until-- 7i7 such time 
as the veteran can be transferred safely
 to a ,department facility or community 
care provider authorized by the         
,secretary and such facility or provider

 is capable of accepting such transfer2 
or  7ii7 such time as a ,department     
facility or community care provider     
authorized by the ,secretary accepts    
such transfer if--  7,i7 at the time the
 veteran could have been transferred    
safely to such a facility or provider1  
no such facility or provider agreed to  
accept such transfer2 and  7,,ii7 the   
non-,department facility in which such  
medical care or services was furnished  
made and documented reasonable attempts 
to transfer the veteran to a ,department
 facility or community care provider4   
7#b7 ,the term health-plan contract     
includes any of the following3 7,a7 ,an 
insurance policy or contract1 medical or
 hospital service agreement1 membership 
or subscription contract1 or similar    
arrangement under which health services 
for individuals are provided or the     
expenses of such services are paid4     
7,b7 ,an insurance program described in 
section #ahaa of the ,social ,security  
,act 7#db ,u4,s4,c4 #acie;c7 or         

established by section #ahca of such    
,act 7#db ,u4,s4,c4 #acie;j74  7,c7 ,a  
,state plan for medical assistance      
approved under title ,,xix of such ,act 
7#db ,u4,s4,c4 #acif et seq474  7,d7 ,a 
workers' compensation law or plan       
described in section #agbi7;a77#b77;,a7 
of this title4  7#c7 ,the term third    
party means any of the following3 7,a7  
,a ,federal entity4  7,b7 ,a ,state or  
political subdivision of a ,state4  7,c7
 ,an employer or an employer's insurance
 carrier4  7,d7 ,an automobile accident 
reparations insurance carrier4  7,e7 ,a 
person or entity obligated to provide1  
or to pay the expenses of1 health       
services under a health-plan contract4  
7#d7 ,the term urgent care shall have   
the meaning given that term by the      
,secretary in regulations prescribed by 
the ,secretary for purposes of this     
section4  4  7b7 ,clerical amendment    
,the table of sections at the beginning 
of chapter #ag is amended by striking   
the item relating to section #agbe and  

inserting the following new item3       
#agbe4 ,reimbursement for emergency     
treatment and urgent care4  4  7c7      
,repeal of superseded authority ,section
 #agbh is repealed4  7d7 ,conforming    
amendments  7#a7 ,medical care for      
survivors and dependents ,section       
#agha7;a77#d7 is amended by striking 7as
 defined in section #agbe7;f7 of this   
title7 and inserting 7as defined in     
section #agbe7;h7 of this title74  7#b7 
,health care of family members of       
veterans stationed at ,camp ,lejeune1   
,north ,carolina ,section #aghg7;b77#c7 
is amended by striking 7as defined in   
section #agbe7;f7 of this title7 and    
inserting 7as defined in section        
#agbe7;h7 of this title74  7e7          
,regulations ,not later than #bgj days  
after the date of the enactment of this 
,act1 the ,secretary shall prescribe    
regulations to carry out the amendments 
made by this section4  7f7 ,effective   
date ,the amendments made by this       
section shall take effect one year after

 the date of the enactment of this ,act4
  #e4 ,memorandum of understanding      
between ,department of ,veterans        
,affairs and ,centers for ,medicare     
,medicaid ,services  7a7 ,sense of      
,congress ,it is the sense of ,congress 
that the ,secretary of ,veterans        
,affairs should ensure that a veteran   
who is enrolled in ,medicare or         
,medicaid1 is eligible for care or      
services under the ,care in the         
,community ,program under section #agjc 
of title #ch1 ,united ,states ,code1 as 
amended by section #b7;a77#a71 and seeks
 care or services for a                 
non-service-connected disability or     
condition1 knows that the veteran may   
use his or her benefits under ,medicare 
or ,medicaid before the ,secretary      
authorizes the use of funds of the      
,department of ,veterans ,affairs4  7b7 
,purpose ,the purpose of this section is
 to facilitate coordination and         
communication between the ,department of
 ,veterans ,affairs and the ,centers for

 ,medicare  ,medicaid ,services for the 
benefit of veterans in the receipt of   
health care4  7c7 ,memorandum of        
understanding  7#a7 ,in general ,the    
,secretary of ,veterans ,affairs and the
 ,administrator of the ,centers for     
,medicare  ,medicaid ,services shall    
enter into a memorandum of understanding
 regarding the coordination of care     
between the ,department of ,veterans    
,affairs and the ,centers for ,medicare 
,medicaid ,services4  7#b7 ,referral of 
patients  7,a7 ,in general ,the         
memorandum of understanding under       
paragraph 7#a7 shall permit health care 
providers of the ,department of         
,veterans ,affairs to refer veterans    
eligible for benefits under ,medicare or
 ,medicaid to non-,department health    
care providers in the community to use  
the ,medicare or ,medicaid benefits of  
such veterans4  7,b7 ,treatment of      
referral ,referral of a veteran under   
subparagraph 7,a7 does not authorize the
 ,secretary of ,veterans ,affairs-- 7i7 

to use funds of the ,department of      
,veterans ,affairs to conduct the       
referral or pay for care or services    
furnished pursuant to such a referral2  
or  7ii7 to furnish care or services to 
the veteran under the ,care in the      
,community ,program under section #agjc 
of title #ch1 ,united ,states ,code1 as 
amended by section #b7;a77#a74  7#c7    
,sharing of information ,as part of the 
memorandum of understanding under       
paragraph 7#a71 the ,secretary and the  
,administrator shall agree to share     
information in connection with the      
coordination of care under such         
memorandum1 including by establishing a 
mechanism to share patient information4 
7#d7 ,technical assistance for ,care in 
the ,community ,program  7,a7 ,in       
general ,as part of the memorandum of   
understanding under paragraph 7#a71 the 
,administrator may provide technical    
assistance to the ,secretary regarding  
the development of a program for        
non-,department health care providers to

 submit claims for reimbursement        
electronically under the ,care in the   
,community ,program under section #agjc 
of title #ch1 ,united ,states ,code1 as 
amended by section #b7;a77#a74  7,b7    
,interoperability and safety of         
information ,in providing technical     
assistance under subparagraph 7,a71 the 
,administrator shall provide advice     
regarding interoperability and methods  
for safeguarding the security of patient
 information4  7,c7 ,use of assistance  
,the ,secretary shall use any technical 
assistance provided under subparagraph  
7,a7 in the development of a web-based  
self-service portal for non-,department 
health care providers to be used under  
subsection 7l7 of section #agjc of title
 #ch1 ,united ,states ,code1 as amended 
by section #b7;a77#a74  7d7 ,education  
program  7#a7 ,in general ,the          
,secretary of ,veterans ,affairs and the
 ,administrator of the ,centers for     
,medicare  ,medicaid ,services shall    
jointly develop and administer an       

education program to inform veterans how
 their benefits from the ,department of 
,veterans ,affairs are separate from and
 interact with their benefits under     
,medicare or ,medicaid4  7#b7 ,elements 
of program ,the education program under 
paragraph 7#a7 shall-- 7,a7 assist      
veterans in making informed decisions   
about when to use benefits from the     
,department and when to use benefits    
under ,medicare or ,medicaid2  7,b7     
provide information on which services   
require referrals from the ,department  
and which services require no referral2 
and  7,c7 explain any financial costs   
that may be required to receive care1   
including copayments under ,medicare or 
from the ,department4  7#c7 ,use of     
memorandum of understanding ,the        
education program under paragraph 7#a7  
may be implemented pursuant to the      
memorandum of understanding under       
subsection 7c74  7e7 ,rule of           
construction ,this section may not be   
construed to authorize or require the   

,secretary of ,veterans ,affairs to     
reimburse the ,administrator of the     
,centers for ,medicare  ,medicaid       
,services for health care services or   
for the ,administrator to reimburse the 
,secretary for such services4  7f7      
,definitions ,in this section3 7#a7     
,medicaid ,the term ,medicaid means the 
,medicaid program under title ,,xix of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif et seq474  7#b7         
,medicare ,the term ,medicare means the 
,medicare program under title ,,xviii of
 such ,act 7#db ,u4,s4,c4 #acie et      
seq474  7#c7 ,non-service-connected ,the
 term non-service-connected has the     
meaning given that term in section #aja 
of title #ch1 ,united ,states ,code4    
#f4 ,education program on health care   
options from ,department of ,veterans   
,affairs  7a7 ,in general ,the          
,secretary of ,veterans ,affairs shall  
develop and administer an education     
program that teaches veterans about     
their health care options through the   

,department of ,veterans ,affairs4  7b7 
,elements ,the program under subsection 
7a7 shall-- 7#a7 teach veterans about-- 
7,a7 eligibility criteria for care from 
the ,department set forth under section 
#agaj of title #ch1 ,united ,states     
,code2  7,b7 priority groups for        
enrollment in the system of annual      
patient enrollment under section        
#agje7;a7 of such title2 and  7,c7 the  
copayments and other financial          
obligations1 if any1 required of certain
 individuals for certain services2  7#b7
 teach veterans about the interaction   
between health insurance 7including     
private insurance1 ,medicare1 ,medicaid1
 the ,,tricare program1 and other forms 
of insurance7 and health care from the  
,department2 and  7#c7 provide veterans 
information on what to do when they have
 a complaint about health care received 
from the ,department 7whether about the 
doctor1 the ,department1 or any other   
type of complaint74  7c7 ,inclusion of  
information from education program on   

,medicare and ,medicaid ,the education  
program under this section shall include
 information from the education program 
under section #f7;d74  7d7              
,accessibility ,in developing the       
education program under this section1   
the ,secretary shall ensure that        
materials under such program are        
accessible to veterans who may not have 
access to the ,internet4  7e7           
,definitions ,in this section3 7#a7     
,medicaid ,the term ,medicaid means the 
,medicaid program under title ,,xix of  
the ,social ,security ,act 7#db         
,u4,s4,c4 #acif et seq474  7#b7         
,medicare ,the term ,medicare means the 
,medicare program under title ,,xviii of
 such ,act 7#db ,u4,s4,c4 #acie et      
seq474  7#c7 ,,tricare program ,the term
 ,,tricare program has the meaning given
 that term in section #ajgb of title    
#aj1 ,united ,states ,code4  #g4        
,training program for administration of 
,non-,department of ,veterans ,affairs  
health care  7a7 ,in general ,the       

,secretary of ,veterans ,affairs shall  
develop and implement a training program
 to train employees and contractors of  
the ,department of ,veterans ,affairs on
 how to administer non-,department      
health care programs1 including the     
following3  7#a7 ,reimbursement for     
non-,department emergency room and      
urgent care under section #agbe of title
 #ch1 ,united ,states ,code4  7#b7 ,the 
,care in the ,community ,program under  
section #agjc of such title1 as amended 
by section #b7;a77#a74  7b7 ,inclusion  
of training on cooperation with ,centers
 for ,medicare  ,medicaid ,services ,the
 training program under subsection 7a7  
shall include training on coordinating  
care between the ,department and        
,medicare and ,medicaid1 including      
pursuant to the memorandum of           
understanding between the ,secretary of 
,veterans ,affairs and the              
,administrator of the ,centers for      
,medicare  ,medicaid ,services under    
section #f7;a74  7c7 ,definitions ,in   

this section3 7#a7 ,medicaid ,the term  
,medicaid means the ,medicaid program   
under title ,,xix of the ,social        
,security ,act 7#db ,u4,s4,c4 #acif et  
seq474  7#b7 ,medicare ,the term        
,medicare means the ,medicare program   
under title ,,xviii of such ,act 7#db   
,u4,s4,c4 #acie et seq474  #h4 ,analysis
 of electronic health record of         
,department of ,veterans ,affairs  7a7  
,in general ,the ,chief ,information    
,officer of the ,veterans ,health       
,administration1 in partnership with the
 ,chief ,information ,officer of the    
,department of ,veterans ,affairs1 shall
 conduct a comprehensive cost-benefit   
analysis among selecting a commercial   
off-the-shelf electronic health record1 
selecting an open source electronic     
health record1 or continuing the        
in-house custom development of the      
,vist,a electronic health record        
currently in use by the ,veterans       
,health ,administration4  7b7 ,elements 
,the analysis conducted under subsection

 7a7 shall-- 7#a7 take into account the 
complexities of the computerized patient
 record system architecture and         
infrastructure of the ,vist,a electronic
 health record and known issues with    
performance1 scalability1 extensibility1
 interoperability1 and security of such 
health record2 and  7#b7 address full   
life-cycle costs1 including development 
time 7based on recent delivery trends71 
availability of development resources1  
maintenance and licensing costs1 and    
infrastructure costs4  7c7 ,report  7#a7
 ,initial report ,not later than        
,september #cj1 #bjag1 the ,secretary of
 ,veterans ,affairs shall submit to the 
,committee on ,veterans' ,affairs of the
 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives a report on the        
progress of the analysis conducted under
 subsection 7a74  7#b7 ,final report    
,not later than ,december #ca1 #bjag1   
the ,secretary shall submit to the      
,committee on ,veterans' ,affairs of the

 ,senate and the ,committee on          
,veterans' ,affairs of the ,house of    
,representatives the results of the     
analysis conducted under subsection 7a74
  #i4 ,reports assessing effectiveness  
of certain positions and offices of     
,department of ,veterans ,affairs  7a7  
,report on ,,cio of ,veterans ,health   
,administration  7#a7 ,in general ,not  
later than ,december #ca1 #bjag1 the    
,secretary of ,veterans ,affairs shall  
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report    
assessing whether the ,chief            
,information ,officer of the ,veterans  
,health ,administration serves as an    
effective advocate for the information  
technology needs of the ,department of  
,veterans ,affairs for health care      
delivery4  7#b7 ,elements ,the report   
required by paragraph 7#a7 shall include
 a description of the requirements for  
an effective health care management     

system that would advance the mission   
and goals of the ,veterans ,health      
,administration4  7#c7 ,use of          
information ,in preparing the report    
under paragraph 7#a71 the ,secretary    
shall include information from the      
,under ,secretary for ,health of the    
,department of ,veterans ,affairs and   
the ,chief ,information ,officer of the 
,department of ,veterans ,affairs4  7b7 
,report on ,office of ,information and  
,technology  7#a7 ,in general ,not later
 than ,december #ca1 #bjag1 the         
,secretary of ,veterans ,affairs shall  
submit to the ,committee on ,veterans'  
,affairs of the ,senate and the         
,committee on ,veterans' ,affairs of the
 ,house of ,representatives a report    
assessing whether the ,office of        
,information and ,technology of the     
,department of ,veterans ,affairs acts  
as a service provider and delivers      
information technology capabilities and 
services that improve health care       
delivery to veterans4  7#b7 ,use of     

survey data ,in preparing the report    
under paragraph 7#a71 the ,secretary    
shall include the results of clinician  
and veteran surveys assessing the       
quality of and satisfaction with        
capabilities and services of the        
,department4  #aj4 ,sense of ,congress  
regarding reforms at the ,veterans      
,health ,administration  7a7 ,findings  
,congress finds that section #bja of the
 ,veterans ,access1 ,choice1 and        
,accountability ,act of #bjad 7,public  
,law #aac-adf2 #ch ,u4,s4,c4 #agja note7
 required an independent assessment of  
the hospital care1 medical services1 and
 other health care furnished in medical 
facilities of the ,department of        
,veterans ,affairs4 ,that assessment    
provided valuable insight into needed   
reforms at the ,veterans ,health        
,administration1 particularly with      
respect to governance1 operations1 data 
and tools1 and leadership4  7b7 ,sense  
of ,congress  7#a7 ,in general ,it is   
the sense of ,congress that the         

,secretary of ,veterans ,affairs should 
take every effort to address as many of 
the reforms described in subsection 7a7 
as practicable4  7#b7 ,elements ,in     
making reforms described in subsection  
7a71 it is the sense of ,congress that  
the ,secretary should do the following3 
7,a7 ,improve the overall management of 
the ,veterans ,health ,administration as
 follows3 7i7 ,by ensuring that the     
,administration provides the decision   
making rights1 authorities1 and         
responsibilities to the lowest          
appropriate level4 ,such decision making
 rights1 authorities1 and               
responsibilities should be articulated  
by level1 organization1 and role1 and   
should be standardized to the extent    
possible while allowing local           
flexibility based on local needs4  7ii7 
,by clarifying the roles and            
responsibilities of the ,central ,office
 of the ,administration1 the ,veterans  
,integrated ,service ,networks1 the     
medical centers of the ,department1 the 

community-based outpatient clinics of   
the ,department1 and other              
organizational entities1 while          
prioritizing providing support to the   
field4  7iii7 ,by reassessing all of the
 directed metrics and policies of the   
,central ,office of the ,administration 
to ensure those metrics and policies add
 sufficient value to patient outcomes4  
,the ,secretary should eliminate the    
metrics and policies that do not add    
sufficient value to patient outcomes4   
7iv7 ,by reviewing the implementation of
 the ,patient ,aligned ,care ,team      
staffing model of the ,department1      
including by determining areas for      
improvement1 to examine--  7,i7 causes  
of gaps in facility benchmarks between  
actual1 maximum1 modeled1 and external  
benchmarks2 and  7,,ii7 impacts on      
access to quality of care and           
appropriateness of performance standards
 and guidelines4  7,b7 ,improve         
collaboration between the ,office of    
,information and ,technology of the     

,department and the ,veterans ,health   
,administration4  7,c7 ,improve resource
 management and business processes by-- 
7i7 prioritizing the use of a           
patient-centered demand model that      
forecasts resources needed by geographic
 location to improve access and make    
informed resourcing decisions2 and  7ii7
 improving coordination across patient  
access1 clinical administration1 and    
patient accounting functions by forming 
an internal committee of key revenue    
cycle and administrative stakeholders1  
standardizing the recovery processes for
 billing1 improving third-party         
contracts management1 and developing    
approaches to resolve frequently        
recurring denials4