,,ii #aae? ,,congress #a/ ,session ,s4 #abgi ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,may #be1 #bjag ,mr4 ,crapo introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,vet]ans' ,affairs ,a ,,bill ,to am5d title #ch1 ,unit$ ,/ates ,code1 to furni% heal? c>e f ! ,dep>tm5t ( ,vet]ans ,affairs ?r\gh ! use ( non-,dep>tm5t heal? c>e provid]s1 & = o!r purposes4 #a4 ,%ort title2 table ( cont5ts 7a7 ,%ort title ,?is ,act may be cit$ z ! ,vet]ans ,heal? ,adm9i/ration ,re=m ,act ( #bjag4 7b7 ,table ( cont5ts ,! table ( cont5ts = ?is ,act is z foll[s3 ,sec4 #a4 ,%ort title2 table ( cont5ts4 ,sec4 #b4 ,e/abli%m5t ( ,c>e 9 ! ,community ,program4 ,sec4 #c4 ,au?orization ( provid] agreem5ts "u ,c>e 9 ! ,community ,program4 ,sec4 #d4 ,expansion ( reimbursem5t ( vet]ans = em]g5cy treatm5t & urg5t c>e4 ,sec4 #e4 ,memor&um ( und]/&+ betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 ,sec4 #f4 ,education program on heal? c>e options f ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #g4 ,tra9+ program = adm9i/ration ( ,non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e4 ,sec4 #h4 ,analysis ( electronic heal? record ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #i4 ,reports assess+ effectiv5ess ( c]ta9 positions & (fices ( ,dep>tm5t ( ,vet]ans ,affairs4 ,sec4 #aj4 ,s5se ( ,congress reg>d+ re=ms at ! ,vet]ans ,heal? ,adm9i/ration4 #b4 ,e/abli%m5t ( ,c>e 9 ! ,community ,program 7a7 ,e/abli%m5t ( program 7#a7 ,9 g5]al ,section #agjc ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ to read z foll[s3 #agjc4 ,c>e 9 ! ,community ,program 7a7 ,9 g5]al 7#a7 ,! ,secret>y may furni% c>e & s]vices describ$ 9 subsection 7c7 to eligible vet]ans describ$ 9 subsection 7b7 f non-,dep>tm5t heal? c>e provid]s ?r\gh ! use ( ,vet]ans ,c>e ,agreem5ts "u section #agjc;,a ( ?is title1 arrangem5ts "u subsection 7d71 or "u any o!r law adm9i/]$ by ! ,secret>y4 ,! furni%+ ( c>e & s]vices "u ?is section may be ref]r$ to z ! ,c>e 9 ! ,community ,program4 7#b7 ,= purposes ( ?is section1 c>e or s]vices furni%$ by ! ,secret>y means t ! ,secret>y au?orizes ! c>e or s]vices & pays = ! c>e or s]vices4 7#c7 ,an eligible vet]an may elect to decl9e to receive c>e or s]vices furni%$ "u ?is section & in/ead receive su* c>e or s]vices at a m$ical facility ( ! ,dep>tm5t4 7b7 ,eligible vet]ans 7#a7 ,a vet]an is an eligible vet]an = purposes ( ?is section if ! vet]an is enroll$ 9 ! sy/em ( annual pati5t enrollm5t e/abli%$ & op]at$ "u section #agje ( ?is title & "o or m ( ! foll[+ conditions apply3 7,a7 ,! ,secret>y det]m9es t x is 9 ! cl9ical be/ int]e/ ( ! vet]an to access c>e or s]vices outside ( ! ,dep>tm5t4 7,b7 ,! vet]an w\ld exp]i5ce an undue burd5 if ! vet]an seeks c>e or s]vices f ! ,dep>tm5t4 7,c7 ,x is n economical = ! ,dep>tm5t to provide ! vet]an ! c>e or s]vices t ! vet]an ne$s4 7#b7 ,a det]m9ation by ! ,secret>y "u p>agraph 7#a77;,a7 %all include an assessm5t ( factors relat+ to ! m$ical or cl9ical condition ( ! vet]an & ! timel9ess ( ! ,dep>tm5t 9 provid+ ! c>e or s]vices requir$ by ! vet]an4 7#c7 ,= purposes ( p>agraph 7#a77;,b71 an undue burd5-- 7,a7 means-- 7i7 an excessive driv+ di/ance1 geographical *all5ges1 or environm5tal factors imp$e ! access ( ! vet]an to c>e or s]vices f ! ,dep>tm5t2 or 7ii7 ! c>e or s]vices s\ght by ! vet]an are n provid$ by a m$ical facility ( ! ,dep>tm5t t is reasonably accessible to ! vet]an2 & 7,b7 may include o!r circum/ances z det]m9$ by ! ,secret>y ^u assess+-- 7i7 ! nature or complexity ( ! c>e or s]vices t ! vet]an requires2 7ii7 ! frequ5cy ) :i* ! vet]an requires su* c>e or s]vices2 & 7iii7 ! ne$ = an att5dant to provide requir$ aid or physical assi/ance to ! vet]an = ! vet]an to travel to a m$ical facility ( ! ,dep>tm5t4 7c7 ,c>e & s]vices describ$ ,c>e & s]vices describ$ 9 ?is subsection are ! foll[+3 7#a7 ,hospital c>e4 7#b7 ,m$ical s]vices4 7#c7 ,diagno/ic c>e4 7#d7 ,) respect to vet]ans describ$ 9 section #agab7;a77#a77;,f7 ( ?is title1 outpati5t d5tal s]vices & treatm5t & relat$ d5tal appliances4 7#e7 ,su* o!r c>e or s]vices z det]m9$ by ! ,secret>y4 7d7 ,arrangem5ts 7#a7 ,! ,secret>y may provide c>e & s]vices "u ?is section ?r\gh arrangem5ts describ$ 9 p>agraph 7#b74 7#b7 ,arrangem5ts describ$ 9 ?is p>agraph are ! foll[+3 7,a7 ,heal? c>e coord9ation & %>+ activities ) ! ,dep>tm5t ( ,def5se "u section #haaa ( ?is title4 7,b7 ,arrangem5ts "u section #haec ( ?is title4 7,c7 ,arrangem5ts betwe5 ! ,secret>y & ! ,director ( ! ,indian ,heal? ,s]vice4 7,d7 ,agreem5ts "u section #agde ( ?is title4 7,e7 ,agreem5ts ) ,f$]ally-qualifi$ heal? c5t]s 7z def9$ 9 section #aije7l77#b77;,b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#c7 ,no?+ 9 ?is section may be con/ru$ to modify ! way ! ,dep>tm5t1 o!r ,f$]al ag5cies1 & ,/ates det]m9e responsibility = paym5t "u arrangem5ts describ$ 9 p>agraph 7#b74 7e7 ,prohibition on collection ( paym5t ,a heal? c>e provid] t provides c>e or s]vices "u ?is section %all agree n to recov] or collect paym5t f-- 7#a7 an eligible vet]an 9 connection ) c>e or s]vices furni%$ "u ?is section2 or 7#b7 a heal?-plan contract or o!r ?ird p>ty on behalf ( ! eligible vet]an 9 connection ) su* c>e or s]vices4 7f7 ,electronic wait+ li/ = c>e at ,dep>tm5t facilities 7#a7 ,if an eligible vet]an seeks c>e or s]vices "u ?is section1 ! ,secret>y %all provide ! vet]an an opportunity to be includ$ on an electronic wait+ li/ ma9ta9$ by ! ,dep>tm5t = an appo9tm5t = c>e or s]vices describ$ 9 subsection 7c7 at a m$ical facility ( ! ,dep>tm5t4 7#b7 ,! electronic wait+ li/ ma9ta9$ "u p>agraph 7#a7 %all all[ access by ea* eligible vet]an via www4myheal?4va4gov or any successor website 7or o!r digital *annel7 = ! foll[+ purposes3 7,a7 ,to det]m9e ! place ( su* eligible vet]an on ! wait+ li/4 7,b7 ,to det]m9e ! av]age l5g? ( "t an individual sp5ds on ! wait+ li/1 disaggregat$ by m$ical facility ( ! ,dep>tm5t & type ( c>e or s]vice ne$$1 = purposes ( all[+ su* eligible vet]an to make an in=m$ election to receive c>e or s]vices "u ?is section or at a m$ical facility ( ! ,dep>tm5t4 7g7 ,in=mation on availability ( c>e ,! ,secret>y %all provide in=mation to a vet]an ab\t ! availability ( c>e & s]vices "u ?is section 9 ! foll[+ circum/ances3 7#a7 ,:5 ! vet]an enrolls 9 ! sy/em ( annual pati5t enrollm5t e/abli%$ & op]at$ "u section #agje ( ?is title4 7#b7 ,:5 ! vet]an attempts to s*$ule an appo9tm5t = ! receipt ( c>e or s]vices describ$ 9 subsection 7c7 f ! ,dep>tm5t b is unable to s*$ule an appo9tm5t )9 ! wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration = ! furni%+ ( su* c>e or s]vices4 7#c7 ,:5 ! vet]an becomes eligible = c>e or s]vices "u ?is section "u subp>agraph 7,a71 7,b71 or 7,c7 ( subsection 7b77#a74 7h7 ,foll[-,up c>e ,9 c>ry+ out ?is section1 ! ,secret>y %all ensure t1 at ! election ( an eligible vet]an :o receives c>e or s]vices f a heal? c>e provid] 9 an episode ( c>e "u ?is section1 ! vet]an receives su* c>e or s]vices f su* heal? c>e provid] ?r\gh ! completion ( ! episode ( c>e 7b = a p]iod n exce$+ "o ye>71 includ+ all specialty & ancill>y s]vices deem$ necess>y z "p ( ! treatm5t recomm5d$ 9 ! c\rse ( su* c>e or s]vices4 7i7 ,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>tm5t4 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>tm5t4 7j7 ,adm9i/ration ( program 7#a7 ,! ,non-,,va ,c>e ,coord9ation ,program ( ! ,dep>tm5t1 work+ jo9tly ) ! ,*ief ,bus9ess ,(fice ( ! ,dep>tm5t1 %all adm9i/] ! ,c>e 9 ! ,community ,program "u ?is section4 7#b7 ,adm9i/ration ( ! ,c>e 9 ! ,community ,program %all include ! foll[+3 7,a7 ,ensur+ t an eligible vet]an receives an appo9tm5t = c>e or s]vices "u ?is section )9-- 7i7 ! wait-"t goals ( ! ,vet]ans ,heal? ,adm9i/ration2 or 7ii7 ! p]iod t a heal? c>e provid] ( ! vet]an at ! ,dep>tm5t det]m9es ! c>e or s]vices are ne$$4 7,b7 ,ensur+ t ! ,secret>y1 includ+ any contractors ( ! ,secret>y1 pay heal? c>e provid]s on "t4 7,c7 ,ensur+ t m$ical in=mation ( an eligible vet]an :o receives c>e or s]vices "u ?is section is s5t to ! heal? c>e provid] ( ! vet]an at ! ,dep>tm5t4 7,d7 ,ensur+ t ! ,secret>y has in=mation reg>d+ any o!r heal? insurance ( an eligible vet]an4 7#c7 ,! ,secret>y %all ensure t ! ,non-,,va ,c>e ,coord9ation ,program ( ! ,dep>tm5t & ! ,*ief ,bus9ess ,(fice ( ! ,dep>tm5t are work+ toge!r effectively & effici5tly ?r\gh\t ! process ( furni%+ c>e "u ?is section4 7#d7 ,! ,secret>y %all notify ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives if any functions "u ?is subsection require alt]ation or realignm5t4 7k7 ,paym5t ( claims 7#a7 ,! ,secret>y %all ensure t all paym5ts ( claims "u ?is section comply ) *apt] #ci ( title #ca 7commonly ref]r$ to z ! ,prompt ,paym5t ,act7 & ! requirem5ts ( ?is subsection4 ,if !re is a conflict betwe5 ! requirem5ts ( ! ,prompt ,paym5t ,act & ! requirem5ts ( ?is subsection1 ! ,secret>y %all comply ) ! requirem5ts ( ?is subsection4 7#b7 7,a7 ,paym5t by ! ,secret>y ( claims "u ?is section %all be issu$1 mail$1 or o!rwise transmitt$ ) respect to n less ?an #ie p]c5t ( all su* claims )9 #cj days aft] ! date on :i* ! claim is receiv$1 if-- 7i7 ! claim is a clean claim2 & 7ii7 ! claim is n "o = :i* paym5t is made on a p]iodic int]im paym5t basis4 7,b7 ,9 ?is p>agraph1 ! t]m clean claim means a claim t has no defect or impropriety 7includ+ any lack ( any requir$ sub/antiat+ docum5tation7 or p>ticul> circum/ance requir+ special treatm5t t prev5ts timely paym5t f be+ made on ! claim "u ?is section4 7#c7 7,a7 ,! ,secret>y is ! prim>y pay] = all c>e or s]vices furni%$ "u ?is section4 7,b7 ,! ,secret>y may recov] or collect reasonable *>ges = c>e or s]vices furni%$ "u ?is section f a ?ird p>ty pursuant to section #agbi ( ?is title or any o!r provision ( law t w\ld p]mit ! ,secret>y to recov] or collect ! co/ ( c>e furni%$ at a facility ( ! ,dep>tm5t or "u ! laws adm9i/]$ by ! ,secret>y4 7l7 ,onl9e portal ,! ,secret>y %all e/abli% an onl9e portal t heal? c>e provid]s p>ticipat+ 9 ! ,c>e 9 ! ,community ,program may use z foll[s3 7#a7 ,to submit m$ical in=mation ) respect to eligible vet]ans furni%$ c>e or s]vices "u ?is section4 7#b7 ,to file claims = paym5t = c>e or s]vices furni%$ "u ?is section4 7#c7 ,to monitor ! /atus ( paym5t ( claims "u ?is section1 includ+ :e!r or n ! claim 0 approv$ or reject$4 7#d7 ,to det]m9e :e!r ! ,secret>y requires additional in=mation be=e process+ ! claim4 7m7 ,annual report on contract c>e 7#a7 ,n lat] ?an ,april #a ea* ye>1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report on heal? c>e contract$ = "u ! laws adm9i/]$ by ! ,secret>y1 includ+ "u ! ,c>e 9 ! ,community ,program4 7#b7 ,ea* report submitt$ "u p>agraph 7#a7 %all-- 7,a7 describe ! use by ! ,secret>y ( ,vet]ans ,c>e ,agreem5ts "u section #agjc;,a ( ?is title1 arrangem5ts "u subsection 7e71 & o!r contracts or agreem5ts = heal? c>e "u ?is section or any o!r law adm9i/]$ by ! ,secret>y2 7,b7 /ate ! numb] ( su* agreem5ts1 arrangem5ts1 or contracts ent]$ into & ! co/s ( su* agreem5ts1 arrangem5ts1 or contracts1 disaggregat$ by m$ical c5t] ( ! ,dep>tm5t2 & 7,c7 include an assessm5t by ! ,c5tral ,(fice ( ! ,vet]ans ,heal? ,adm9i/ration ( ! ef=ts ( su* (fice to coord9ate su* agreem5ts1 arrangem5ts1 or contracts4 7n7 ,rule ( con/ruction ,no?+ 9 ?is section or section #agjc;,a ( ?is title %all be con/ru$ to prev5t ! ,secret>y f ent]+ into regional or national contracts to provide prescription m$ication1 dialysis treatm5t1 pro/hetics1 & su* o!r c>e or s]vices "u ?is section z ! ,secret>y consid]s appropriate4 4 7#b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag ( su* title is am5d$ by /rik+ ! item relat$ to section #agjc & ins]t+ ! foll[+ new item3 #agjc4 ,c>e 9 ! ,community ,program4 4 7#c7 ,report on developm5t & implem5tation ( onl9e portal 7,a7 ,9 g5]al ,n lat] ?an ,decemb] #ca1 #bjag1 ! ,"u ,secret>y = ,heal? ( ! ,dep>tm5t ( ,vet]ans ,affairs %all submit to ,congress a report on ! developm5t & implem5tation by ! ,dep>tm5t ( ,vet]ans ,affairs ( ! onl9e portal e/abli%$ "u subsection 7m7 ( section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z add$ by p>agraph 7#a71 = ! process+ ( claims by heal? c>e provid]s "u ! ,c>e 9 ! ,community ,program "u su* section4 7,b7 ,elem5ts ,! report requir$ by subp>agraph 7,a7 %all include ! foll[+3 7i7 ,a detail$ s*$ule = develop+ & implem5t+ ! onl9e portal describ$ 9 subp>agraph 7,a74 7ii7 ,an assessm5t ( :e!r ! onl9e portal includes ! foll[+ elem5ts3 7,i7 ,automatic adjudication ( claims4 7,,ii7 ,automat$ entry ( au?orizations = c>e or s]vices4 7,,iii7 ,a me*anism by :i* heal? c>e provid]s c electronically submit m$ical records1 includ+ heal? c>e provid]s t a vet]an may h se5 )\t au?orization f ! ,dep>tm5t4 7,,iv7 ,a web-bas$ portal = heal? c>e provid]s to *eck ! /atus ( _! claims4 7iii7 ,e/imat$ co/s = develop+ & implem5t+ ea* aspect ( ! onl9e portal4 7iv7 ,p]=mance goals1 measures1 & int]im mile/ones t ! ,"u ,secret>y = ,heal? w use to evaluate progress1 hold /aff acc\ntable = a*iev+ desir$ results1 & report to /akehold]s on ! impact ( ! onl9e portal 9 mod]niz+ ! claims process+ sy/em ( ! ,dep>tm5t4 7b7 ,con=m+ am5dm5ts 7#a7 ,d5tal c>e ,section #agab7;a77#c7 ( title #ch1 ,unit$ ,/ates ,code1 is am5d$1 9 p>agraph 7#c71 by /rik+ "u clause 7#a71 7#b71 or 7#e7 ( section #agjc7;a7 ( ?is title & ins]t+ "u section #agjc ( ?is title4 7#b7 ,readju/m5t c\nsel+ ,section #agab;,a7e77#a7 ( su* title is am5d$ by /rik+ sections #agjc7;a77#b7 & #agaj7;a77#a77;,b7 ( ?is title & ins]t+ sections #agjc & #agaj7;a77#a77;,b7 ( ?is title4 7#c7 ,con=m+ repeal ( sup]s$$ au?ority 7,a7 ,9 g5]al ,section #aja ( ! ,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 #bjh ( su* ,act is am5d$-- 7i7 9 p>agraph 7#a71 by /rik+ hospital c>e & m$ical s]vices "u section #aja & ins]t+ c>e & s]vices "u section #agjc ( title #ch1 ,unit$ ,/ates ,code2 & 7ii7 9 p>agraph 7#b71 by /rik+ hospital c>e & m$ical s]vices & ins]t+ c>e & s]vices4 7c7 ,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 #c4 ,au?orization ( provid] agreem5ts "u ,c>e 9 ! ,community ,program 7a7 ,9 g5]al ,sub*apt] ,i ( *apt] #ag ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ by ins]t+ aft] section #agjc ! foll[+ new section3 #agjc;,a4 ,c>e 9 ! ,community ,program3 provid] agreem5ts 7a7 ,agreem5ts ,to ,furni% ,c>e ,! ,secret>y may furni% c>e & s]vices "u ! ,c>e 9 ! ,community ,program "u section #agjc ( ?is title by ent]+ into agreem5ts "u ?is section ) eligible provid]s t are c]tifi$ "u subsection 7c74 7b7 ,eligible provid]s ,= purposes ( ?is section1 an eligible provid] is "o ( ! foll[+3 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;cc7a774 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 #acieu7h774 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 plan4 7#d7 ,a provid] t is-- 7,a7 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,b7 a c5t] = indep5d5t liv+ 7z def9$ 9 section #gjb ( ! ,rehabilitation ,act ( #aigc 7#bi ,u4,s4,c4 #gif;a774 7#e7 ,su* o!r heal? c>e provid]s z ! ,secret>y consid]s appropriate = purposes ( ?is section4 7c7 ,c]tification ( eligible provid]s ,! ,secret>y %all e/abli% a process = ! c]tification ( eligible provid]s "u ?is section4 7d7 ,rates = c>e & s]vices 7#a7 ,except z o!rwise provid$ 9 ?is subsection1 an eligible provid] t ent]s into an agreem5t "u ?is section to provide c>e or s]vices "u section #agjc ( ?is title %all agree to accept z paym5t 9 full = su* c>e or s]vices an am\nt equal to ! rate 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 7#b7 7,a7 ,a high] rate ?an ! rate paid by ! ,unit$ ,/ates z describ$ 9 p>agraph 7#a7 may be negotiat$ ) respect to ! furni%+ ( c>e or s]vices to a vet]an :o resides 9 a highly rural area4 7,b7 ,9 ?is p>agraph1 ! t]m highly rural area means an area locat$ 9 a c\nty t has few] ?an sev5 individuals resid+ 9 t c\nty p] squ>e mile4 7#c7 ,) respect to furni%+ c>e or s]vices "u ?is subsection 9 ,alaska1 ! ,alaska ,fee ,s*$ule ( ! ,dep>tm5t ( ,vet]ans ,affairs %all be foll[$1 except = :5 ano!r paym5t agreem5t1 includ+ a contract or provid] agreem5t1 is 9 place4 7#d7 ,) respect to furni%+ c>e or s]vices "u ?is subsection 9 a ,/ate ) an ,all-,pay] ,model ,agreem5t "u section #ahad7;b77#c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7b77#c77 t became effective on ,janu>y #a1 #bjad1 ! ,m$ic>e paym5t rates "u subp>agraph 7,a7 %all be calculat$ bas$ on ! paym5t rates "u su* agreem5t4 7#e7 ,) respect to furni%+ c>e or s]vices "u ?is subsection = :i* !re is n a rate paid "u ! ,m$ic>e program z describ$ 9 p>agraph 7#a71 su* z d5tal c>e1 ob/etrics & gynecology1 & o!r s]vices1 ! rate paid = su* c>e or s]vices %all be det]m9$ by ! ,secret>y4 7#f7 ,9 det]m9+ rates & mak+ paym5ts "u ?is subsection1 ! ,secret>y may conduct pilot programs on alt]native paym5t sy/ems simil> to ^? us$ "u ! ,m$ic>e program1 includ+ ! ,m]it-bas$ ,inc5tive ,paym5t ,sy/em "u section #ahdh7q7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7q77 & alt]native paym5t models 7z def9$ 9 section #ahcc7z77#c77;,c7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciel7z77#c77;,c7774 7#g7 ,if a high] rate ?an ! rate specifi$ 9 p>agraph 7#a7 is det]m9$ "u ?is subsection1 ! ,secret>y %all notify ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices reg>d+ su* high] rate4 7e7 ,treatm5t ( c]ta9 laws 7#a7 ,an agreem5t "u ?is section may be ent]$ into )\t reg>d to any contract+ law t w\ld require ! ,secret>y to use competitive proc$ures 9 select+ ! p>ty ) :i* to ent] into ! agreem5t4 7#b7 7,a7 ,except z provid$ 9 subp>agraph 7,b7 & unless o!rwise provid$ 9 ?is section or regulations prescrib$ pursuant to ?is section1 an eligible provid] t ent]s into an agreem5t "u ?is section is n subject to1 9 ! c>ry+ out ( ! agreem5t1 any contract+ law t an eligible provid] describ$ 9 subsection 7b77#a71 7b77#b71 or 7b77#c7 is n subject to "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 7,b7 ,! exclusion "u subp>agraph 7,a7 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 an eligible provid] t ent]s into an agreem5t "u ?is section to ! same ext5t z su* title applies ) respect to ! eligible provid] 9 provid+ c>e or s]vices ?r\gh an agreem5t or arrangem5t o!r ?an "u ?is section4 4 7b7 ,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 ,c>e 9 ! ,community ,program3 provid] agreem5ts4 4 #d4 ,expansion ( reimbursem5t ( vet]ans = em]g5cy treatm5t & urg5t c>e 7a7 ,9 g5]al ,section #agbe ( title #ch1 ,unit$ ,/ates ,code1 is am5d$ to read z foll[s3 #agbe4 ,reimbursem5t = em]g5cy treatm5t & urg5t c>e 7a7 ,9 g5]al 7#a7 ,subject to ! provisions ( ?is section1 ! ,secret>y %all reimburse a vet]an describ$ 9 subsection 7b7 = ! reasonable value ( em]g5cy treatm5t or urg5t c>e furni%$ ! vet]an 9 a non-,dep>tm5t facility4 7#b7 ,9 any case 9 :i* reimbursem5t ( a vet]an is au?oriz$ "u p>agraph 7#a71 ! ,secret>y may1 9 lieu ( reimburs+ ! vet]an1 make paym5t ( ! reasonable value ( ! furni%$ em]g5cy treatm5t or urg5t c>e directly-- 7,a7 to ! hospital or o!r heal? c>e provid] t furni%$ ! treatm5t or c>e2 or 7,b7 to ! p]son or organization t paid = su* treatm5t or c>e on behalf ( ! vet]an4 7b7 ,eligibility ,a vet]an describ$ 9 ?is subsection is an individual :o-- 7#a7 is enroll$ 9 ! pati5t enrollm5t sy/em ( ! ,dep>tm5t e/abli%$ & op]at$ "u section #agje ( ?is title2 & 7#b7 has receiv$ c>e "u ?is *apt] dur+ ! #bd-mon? p]iod prec$+ ! furni%+ ( ! em]g5cy treatm5t or urg5t c>e = :i* reimbursem5t is s\ght "u ?is section4 7c7 ,em]g5cy transportation ,not)/&+ section #aaa ( ?is title1 reimbursem5t ( em]g5cy treatm5t or urg5t c>e "u ?is section %all include reimbursem5t = ! reasonable value ( em]g5cy transportation4 7d7 ,responsibility = paym5t ,! ,secret>y %all be prim>ily responsible = reimburs+ or o!rwise pay+ ! reasonable value ( em]g5cy treatm5t or urg5t c>e "u ?is section4 7e7 ,limitations on paym5t 7#a7 ,! ,secret>y1 9 accordance ) regulations prescrib$ by ! ,secret>y = purposes ( ?is section1 %all-- 7,a7 e/abli% ! maximum am\nt payable "u subsection 7a72 & 7,b7 del9eate ! circum/ances "u :i* su* paym5ts may be made1 includ+ su* requirem5ts on reque/+ reimbursem5t z ! ,secret>y may e/abli%4 7#b7 7,a7 ,paym5t by ! ,secret>y "u ?is section on behalf ( a vet]an to a provid] ( em]g5cy treatm5t or urg5t c>e %all1 unless reject$ & refund$ by ! provid] )9 #cj days ( receipt-- 7i7 con/itute paym5t 9 full = ! em]g5cy treatm5t or urg5t c>e provid$2 & 7ii7 ext+ui% any liability on ! "p ( ! vet]an = t treatm5t or c>e4 7,b7 ,nei!r ! abs5ce ( a contract or agreem5t betwe5 ! ,secret>y & a provid] ( em]g5cy treatm5t or urg5t c>e nor any provision ( a contract1 agreem5t1 or assignm5t to ! contr>y %all op]ate to modify1 limit1 or negate ! requirem5ts ( subp>agraph 7,a74 7,c7 ,a provid] ( em]g5cy treatm5t or urg5t c>e may n seek to recov] f any ?ird p>ty ! co/ ( em]g5cy treatm5t or urg5t c>e = :i* ! provid] has receiv$ paym5t f ! ,secret>y "u ?is section4 7f7 ,recov]y ,! ,unit$ ,/ates has ! "r to recov] or collect reasonable *>ges = em]g5cy treatm5t or urg5t c>e furni%$ "u ?is section 9 accordance ) ! provisions ( section #agbi ( ?is title4 7g7 ,co/ %>+ 7#a7 ,! ,secret>y %all require a vet]an to pay a copaym5t = ! receipt ( em]g5cy treatm5t or urg5t c>e "u ?is section only if su* vet]an w\ld be requir$ to pay a copaym5t = ! receipt ( su* treatm5t or c>e at a m$ical facility ( ! ,dep>tm5t or f a heal? c>e provid] ( ! ,dep>tm5t4 7#b7 ,! am\nt ( a copaym5t *>g$ to a vet]an "u p>agraph 7#a7 may n exce$ ! am\nt ( ! copaym5t t w\ld be payable by su* vet]an = ! receipt ( em]g5cy treatm5t or urg5t c>e at a m$ical facility ( ! ,dep>tm5t or f a heal? c>e provid] ( ! ,dep>tm5t4 7h7 ,def9itions ,9 ?is section3 7#a7 ,! t]m em]g5cy treatm5t means m$ical c>e or s]vices furni%$1 9 ! judgm5t ( ! ,secret>y-- 7,a7 :5 su* c>e or s]vices are r5d]$ 9 a m$ical em]g5cy ( su* nature t a prud5t layp]son reasonably expects t delay 9 seek+ imm$iate m$ical att5tion w\ld be haz>d\s to life or heal?2 & 7,b7 until-- 7i7 su* "t z ! vet]an c be transf]r$ safely to a ,dep>tm5t facility or community c>e provid] au?oriz$ by ! ,secret>y & su* facility or provid] is capable ( accept+ su* transf]2 or 7ii7 su* "t z a ,dep>tm5t facility or community c>e provid] au?oriz$ by ! ,secret>y accepts su* transf] if-- 7,i7 at ! "t ! vet]an c\ld h be5 transf]r$ safely to su* a facility or provid]1 no su* facility or provid] agre$ to accept su* transf]2 & 7,,ii7 ! non-,dep>tm5t facility 9 :i* su* m$ical c>e or s]vices 0 furni%$ made & docum5t$ reasonable attempts to transf] ! vet]an to a ,dep>tm5t facility or community c>e provid]4 7#b7 ,! t]m heal?-plan contract includes any ( ! foll[+3 7,a7 ,an insurance policy or contract1 m$ical or hospital s]vice agreem5t1 memb]%ip or subscription contract1 or simil> arrangem5t "u :i* heal? s]vices = individuals are provid$ or ! exp5ses ( su* s]vices are paid4 7,b7 ,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;j74 7,c7 ,a ,/ate plan = m$ical assi/ance approv$ "u title ,,xix ( su* ,act 7#db ,u4,s4,c4 #acif et seq474 7,d7 ,a work]s' comp5sation law or plan describ$ 9 section #agbi7;a77#b77;,a7 ( ?is title4 7#c7 ,! t]m ?ird p>ty means any ( ! foll[+3 7,a7 ,a ,f$]al entity4 7,b7 ,a ,/ate or political subdivision ( a ,/ate4 7,c7 ,an employ] or an employ]'s insurance c>ri]4 7,d7 ,an automobile accid5t rep>ations insurance c>ri]4 7,e7 ,a p]son or entity obligat$ to provide1 or to pay ! exp5ses (1 heal? s]vices "u a heal?-plan contract4 7#d7 ,! t]m urg5t c>e %all h ! mean+ giv5 t t]m by ! ,secret>y 9 regulations prescrib$ by ! ,secret>y = purposes ( ?is section4 4 7b7 ,cl]ical am5dm5t ,! table ( sections at ! beg9n+ ( *apt] #ag is am5d$ by /rik+ ! item relat+ to section #agbe & ins]t+ ! foll[+ new item3 #agbe4 ,reimbursem5t = em]g5cy treatm5t & urg5t c>e4 4 7c7 ,repeal ( sup]s$$ au?ority ,section #agbh is repeal$4 7d7 ,con=m+ am5dm5ts 7#a7 ,m$ical c>e = survivors & dep5d5ts ,section #agha7;a77#d7 is am5d$ by /rik+ 7z def9$ 9 section #agbe7;f7 ( ?is title7 & ins]t+ 7z def9$ 9 section #agbe7;h7 ( ?is title74 7#b7 ,heal? c>e ( family memb]s ( vet]ans /ation$ at ,camp ,lejeune1 ,nor? ,c>ol9a ,section #aghg7;b77#c7 is am5d$ by /rik+ 7z def9$ 9 section #agbe7;f7 ( ?is title7 & ins]t+ 7z def9$ 9 section #agbe7;h7 ( ?is title74 7e7 ,regulations ,n lat] ?an #bgj days aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y %all prescribe regulations to c>ry out ! am5dm5ts made by ?is section4 7f7 ,effective date ,! am5dm5ts made by ?is section %all take effect "o ye> aft] ! date ( ! enactm5t ( ?is ,act4 #e4 ,memor&um ( und]/&+ betwe5 ,dep>tm5t ( ,vet]ans ,affairs & ,c5t]s = ,m$ic>e ,m$icaid ,s]vices 7a7 ,s5se ( ,congress ,x is ! s5se ( ,congress t ! ,secret>y ( ,vet]ans ,affairs %\ld ensure t a vet]an :o is enroll$ 9 ,m$ic>e or ,m$icaid1 is eligible = c>e or s]vices "u ! ,c>e 9 ! ,community ,program "u section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #b7;a77#a71 & seeks c>e or s]vices = a non-s]vice-connect$ disability or condition1 kn[s t ! vet]an may use 8 or h] b5efits "u ,m$ic>e or ,m$icaid be=e ! ,secret>y au?orizes ! use ( funds ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,purpose ,! purpose ( ?is section is to facilitate coord9ation & communication betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices = ! b5efit ( vet]ans 9 ! receipt ( heal? c>e4 7c7 ,memor&um ( und]/&+ 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all ent] into a memor&um ( und]/&+ reg>d+ ! coord9ation ( c>e betwe5 ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices4 7#b7 ,ref]ral ( pati5ts 7,a7 ,9 g5]al ,! memor&um ( und]/&+ "u p>agraph 7#a7 %all p]mit heal? c>e provid]s ( ! ,dep>tm5t ( ,vet]ans ,affairs to ref] vet]ans eligible = b5efits "u ,m$ic>e or ,m$icaid to non-,dep>tm5t heal? c>e provid]s 9 ! community to use ! ,m$ic>e or ,m$icaid b5efits ( su* vet]ans4 7,b7 ,treatm5t ( ref]ral ,ref]ral ( a vet]an "u subp>agraph 7,a7 does n au?orize ! ,secret>y ( ,vet]ans ,affairs-- 7i7 to use funds ( ! ,dep>tm5t ( ,vet]ans ,affairs to conduct ! ref]ral or pay = c>e or s]vices furni%$ pursuant to su* a ref]ral2 or 7ii7 to furni% c>e or s]vices to ! vet]an "u ! ,c>e 9 ! ,community ,program "u section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #b7;a77#a74 7#c7 ,%>+ ( in=mation ,z "p ( ! memor&um ( und]/&+ "u p>agraph 7#a71 ! ,secret>y & ! ,adm9i/rator %all agree to %>e in=mation 9 connection ) ! coord9ation ( c>e "u su* memor&um1 includ+ by e/abli%+ a me*anism to %>e pati5t in=mation4 7#d7 ,te*nical assi/ance = ,c>e 9 ! ,community ,program 7,a7 ,9 g5]al ,z "p ( ! memor&um ( und]/&+ "u p>agraph 7#a71 ! ,adm9i/rator may provide te*nical assi/ance to ! ,secret>y reg>d+ ! developm5t ( a program = non-,dep>tm5t heal? c>e provid]s to submit claims = reimbursem5t electronically "u ! ,c>e 9 ! ,community ,program "u section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #b7;a77#a74 7,b7 ,int]op]ability & safety ( in=mation ,9 provid+ te*nical assi/ance "u subp>agraph 7,a71 ! ,adm9i/rator %all provide advice reg>d+ int]op]ability & me?ods = safegu>d+ ! security ( pati5t in=mation4 7,c7 ,use ( assi/ance ,! ,secret>y %all use any te*nical assi/ance provid$ "u subp>agraph 7,a7 9 ! developm5t ( a web-bas$ self-s]vice portal = non-,dep>tm5t heal? c>e provid]s to be us$ "u subsection 7l7 ( section #agjc ( title #ch1 ,unit$ ,/ates ,code1 z am5d$ by section #b7;a77#a74 7d7 ,education program 7#a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices %all jo9tly develop & adm9i/] an education program to in=m vet]ans h[ _! b5efits f ! ,dep>tm5t ( ,vet]ans ,affairs are sep>ate f & int]act ) _! b5efits "u ,m$ic>e or ,m$icaid4 7#b7 ,elem5ts ( program ,! education program "u p>agraph 7#a7 %all-- 7,a7 assi/ vet]ans 9 mak+ in=m$ decisions ab\t :5 to use b5efits f ! ,dep>tm5t & :5 to use b5efits "u ,m$ic>e or ,m$icaid2 7,b7 provide in=mation on :i* s]vices require ref]rals f ! ,dep>tm5t & :i* s]vices require no ref]ral2 & 7,c7 expla9 any f9ancial co/s t may be requir$ to receive c>e1 includ+ copaym5ts "u ,m$ic>e or f ! ,dep>tm5t4 7#c7 ,use ( memor&um ( und]/&+ ,! education program "u p>agraph 7#a7 may be implem5t$ pursuant to ! memor&um ( und]/&+ "u subsection 7c74 7e7 ,rule ( con/ruction ,?is section may n be con/ru$ to au?orize or require ! ,secret>y ( ,vet]ans ,affairs to reimburse ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices = heal? c>e s]vices or = ! ,adm9i/rator to reimburse ! ,secret>y = su* s]vices4 7f7 ,def9itions ,9 ?is section3 7#a7 ,m$icaid ,! t]m ,m$icaid means ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#b7 ,m$ic>e ,! t]m ,m$ic>e means ! ,m$ic>e program "u title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #acie et seq474 7#c7 ,non-s]vice-connect$ ,! t]m non-s]vice-connect$ has ! mean+ giv5 t t]m 9 section #aja ( title #ch1 ,unit$ ,/ates ,code4 #f4 ,education program on heal? c>e options f ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all develop & adm9i/] an education program t tea*es vet]ans ab\t _! heal? c>e options ?r\gh ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,elem5ts ,! program "u subsection 7a7 %all-- 7#a7 tea* vet]ans ab\t-- 7,a7 eligibility crit]ia = c>e f ! ,dep>tm5t set =? "u section #agaj ( title #ch1 ,unit$ ,/ates ,code2 7,b7 priority gr\ps = enrollm5t 9 ! sy/em ( annual pati5t enrollm5t "u section #agje7;a7 ( su* title2 & 7,c7 ! copaym5ts & o!r f9ancial obligations1 if any1 requir$ ( c]ta9 individuals = c]ta9 s]vices2 7#b7 tea* vet]ans ab\t ! int]action betwe5 heal? insurance 7includ+ private insurance1 ,m$ic>e1 ,m$icaid1 ! ,,tric>e program1 & o!r =ms ( insurance7 & heal? c>e f ! ,dep>tm5t2 & 7#c7 provide vet]ans in=mation on :at to d :5 !y h a compla9t ab\t heal? c>e receiv$ f ! ,dep>tm5t 7:e!r ab\t ! doctor1 ! ,dep>tm5t1 or any o!r type ( compla9t74 7c7 ,inclusion ( in=mation f education program on ,m$ic>e & ,m$icaid ,! education program "u ?is section %all include in=mation f ! education program "u section #f7;d74 7d7 ,accessibility ,9 develop+ ! education program "u ?is section1 ! ,secret>y %all ensure t mat]ials "u su* program are accessible to vet]ans :o may n h access to ! ,int]net4 7e7 ,def9itions ,9 ?is section3 7#a7 ,m$icaid ,! t]m ,m$icaid means ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#b7 ,m$ic>e ,! t]m ,m$ic>e means ! ,m$ic>e program "u title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #acie et seq474 7#c7 ,,tric>e program ,! t]m ,,tric>e program has ! mean+ giv5 t t]m 9 section #ajgb ( title #aj1 ,unit$ ,/ates ,code4 #g4 ,tra9+ program = adm9i/ration ( ,non-,dep>tm5t ( ,vet]ans ,affairs heal? c>e 7a7 ,9 g5]al ,! ,secret>y ( ,vet]ans ,affairs %all develop & implem5t a tra9+ program to tra9 employees & contractors ( ! ,dep>tm5t ( ,vet]ans ,affairs on h[ to adm9i/] non-,dep>tm5t heal? c>e programs1 includ+ ! foll[+3 7#a7 ,reimbursem5t = non-,dep>tm5t em]g5cy room & urg5t c>e "u section #agbe ( title #ch1 ,unit$ ,/ates ,code4 7#b7 ,! ,c>e 9 ! ,community ,program "u section #agjc ( su* title1 z am5d$ by section #b7;a77#a74 7b7 ,inclusion ( tra9+ on coop]ation ) ,c5t]s = ,m$ic>e ,m$icaid ,s]vices ,! tra9+ program "u subsection 7a7 %all include tra9+ on coord9at+ c>e betwe5 ! ,dep>tm5t & ,m$ic>e & ,m$icaid1 includ+ pursuant to ! memor&um ( und]/&+ betwe5 ! ,secret>y ( ,vet]ans ,affairs & ! ,adm9i/rator ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices "u section #f7;a74 7c7 ,def9itions ,9 ?is section3 7#a7 ,m$icaid ,! t]m ,m$icaid means ! ,m$icaid program "u title ,,xix ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq474 7#b7 ,m$ic>e ,! t]m ,m$ic>e means ! ,m$ic>e program "u title ,,xviii ( su* ,act 7#db ,u4,s4,c4 #acie et seq474 #h4 ,analysis ( electronic heal? record ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,9 g5]al ,! ,*ief ,in=mation ,(fic] ( ! ,vet]ans ,heal? ,adm9i/ration1 9 p>tn]%ip ) ! ,*ief ,in=mation ,(fic] ( ! ,dep>tm5t ( ,vet]ans ,affairs1 %all conduct a compreh5sive co/-b5efit analysis among select+ a comm]cial (f-!-%elf electronic heal? record1 select+ an op5 s\rce electronic heal? record1 or cont9u+ ! 9-h\se cu/om developm5t ( ! ,vist,a electronic heal? record curr5tly 9 use by ! ,vet]ans ,heal? ,adm9i/ration4 7b7 ,elem5ts ,! analysis conduct$ "u subsection 7a7 %all-- 7#a7 take into acc\nt ! complexities ( ! comput]iz$ pati5t record sy/em ar*itecture & infra/ructure ( ! ,vist,a electronic heal? record & kn[n issues ) p]=mance1 scalability1 ext5sibility1 int]op]ability1 & security ( su* heal? record2 & 7#b7 address full life-cycle co/s1 includ+ developm5t "t 7bas$ on rec5t deliv]y tr5ds71 availability ( developm5t res\rces1 ma9t5ance & lic5s+ co/s1 & infra/ructure co/s4 7c7 ,report 7#a7 ,initial report ,n lat] ?an ,septemb] #cj1 #bjag1 ! ,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 ! progress ( ! analysis conduct$ "u subsection 7a74 7#b7 ,f9al report ,n lat] ?an ,decemb] #ca1 #bjag1 ! ,secret>y %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives ! results ( ! analysis conduct$ "u subsection 7a74 #i4 ,reports assess+ effectiv5ess ( c]ta9 positions & (fices ( ,dep>tm5t ( ,vet]ans ,affairs 7a7 ,report on ,,cio ( ,vet]ans ,heal? ,adm9i/ration 7#a7 ,9 g5]al ,n lat] ?an ,decemb] #ca1 #bjag1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report assess+ :e!r ! ,*ief ,in=mation ,(fic] ( ! ,vet]ans ,heal? ,adm9i/ration s]ves z an effective advocate = ! in=mation te*nology ne$s ( ! ,dep>tm5t ( ,vet]ans ,affairs = heal? c>e deliv]y4 7#b7 ,elem5ts ,! report requir$ by p>agraph 7#a7 %all include a description ( ! requirem5ts = an effective heal? c>e managem5t sy/em t w\ld advance ! mission & goals ( ! ,vet]ans ,heal? ,adm9i/ration4 7#c7 ,use ( in=mation ,9 prep>+ ! report "u p>agraph 7#a71 ! ,secret>y %all include in=mation f ! ,"u ,secret>y = ,heal? ( ! ,dep>tm5t ( ,vet]ans ,affairs & ! ,*ief ,in=mation ,(fic] ( ! ,dep>tm5t ( ,vet]ans ,affairs4 7b7 ,report on ,(fice ( ,in=mation & ,te*nology 7#a7 ,9 g5]al ,n lat] ?an ,decemb] #ca1 #bjag1 ! ,secret>y ( ,vet]ans ,affairs %all submit to ! ,committee on ,vet]ans' ,affairs ( ! ,s5ate & ! ,committee on ,vet]ans' ,affairs ( ! ,h\se ( ,repres5tatives a report assess+ :e!r ! ,(fice ( ,in=mation & ,te*nology ( ! ,dep>tm5t ( ,vet]ans ,affairs acts z a s]vice provid] & deliv]s in=mation te*nology capabilities & s]vices t improve heal? c>e deliv]y to vet]ans4 7#b7 ,use ( survey data ,9 prep>+ ! report "u p>agraph 7#a71 ! ,secret>y %all include ! results ( cl9ician & vet]an surveys assess+ ! quality ( & satisfaction ) capabilities & s]vices ( ! ,dep>tm5t4 #aj4 ,s5se ( ,congress reg>d+ re=ms at ! ,vet]ans ,heal? ,adm9i/ration 7a7 ,f9d+s ,congress f9ds t section #bja ( ! ,vet]ans ,access1 ,*oice1 & ,acc\ntability ,act ( #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 requir$ an indep5d5t assessm5t ( ! hospital c>e1 m$ical s]vices1 & o!r heal? c>e furni%$ 9 m$ical facilities ( ! ,dep>tm5t ( ,vet]ans ,affairs4 ,t assessm5t provid$ valuable insight into ne$$ re=ms at ! ,vet]ans ,heal? ,adm9i/ration1 p>ticul>ly ) respect to gov]nance1 op]ations1 data & tools1 & lead]%ip4 7b7 ,s5se ( ,congress 7#a7 ,9 g5]al ,x is ! s5se ( ,congress t ! ,secret>y ( ,vet]ans ,affairs %\ld take e ef=t to address z _m ( ! re=ms describ$ 9 subsection 7a7 z practicable4 7#b7 ,elem5ts ,9 mak+ re=ms describ$ 9 subsection 7a71 x is ! s5se ( ,congress t ! ,secret>y %\ld d ! foll[+3 7,a7 ,improve ! ov]all managem5t ( ! ,vet]ans ,heal? ,adm9i/ration z foll[s3 7i7 ,by ensur+ t ! ,adm9i/ration provides ! decision mak+ rights1 au?orities1 & responsibilities to ! l[e/ appropriate level4 ,su* decision mak+ rights1 au?orities1 & responsibilities %\ld be articulat$ by level1 organization1 & role1 & %\ld be /&>diz$ to ! ext5t possible :ile all[+ local flexibility bas$ on local ne$s4 7ii7 ,by cl>ify+ ! roles & responsibilities ( ! ,c5tral ,(fice ( ! ,adm9i/ration1 ! ,vet]ans ,integrat$ ,s]vice ,networks1 ! m$ical c5t]s ( ! ,dep>tm5t1 ! community-bas$ outpati5t cl9ics ( ! ,dep>tm5t1 & o!r organizational entities1 :ile prioritiz+ provid+ support to ! field4 7iii7 ,by reassess+ all ( ! direct$ metrics & policies ( ! ,c5tral ,(fice ( ! ,adm9i/ration to ensure ^? metrics & policies add suffici5t value to pati5t outcomes4 ,! ,secret>y %\ld elim9ate ! metrics & policies t d n add suffici5t value to pati5t outcomes4 7iv7 ,by review+ ! implem5tation ( ! ,pati5t ,align$ ,c>e ,team /aff+ model ( ! ,dep>tm5t1 includ+ by det]m9+ areas = improvem5t1 to exam9e-- 7,i7 causes ( gaps 9 facility b5*m>ks betwe5 actual1 maximum1 model$1 & ext]nal b5*m>ks2 & 7,,ii7 impacts on access to quality ( c>e & appropriat5ess ( p]=mance /&>ds & guidel9es4 7,b7 ,improve collaboration betwe5 ! ,(fice ( ,in=mation & ,te*nology ( ! ,dep>tm5t & ! ,vet]ans ,heal? ,adm9i/ration4 7,c7 ,improve res\rce managem5t & bus9ess processes by-- 7i7 prioritiz+ ! use ( a pati5t-c5t]$ dem& model t =eca/s res\rces ne$$ by geographic location to improve access & make in=m$ res\rc+ decisions2 & 7ii7 improv+ coord9ation across pati5t access1 cl9ical adm9i/ration1 & pati5t acc\nt+ functions by =m+ an int]nal committee ( key rev5ue cycle & adm9i/rative /akehold]s1 /&>diz+ ! recov]y processes = bill+1 improv+ ?ird-p>ty contracts managem5t1 & develop+ approa*es to resolve frequ5tly recurr+ d5ials4