,,ii #aaeth ,,congress #ast ,session ,s4 #bahd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #a1 #bjag ,mr4 ,mc,cain 7for himself and ,mr4 ,moran7 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 improve veterans' health care benefits1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,veterans ,community ,care and ,access ,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 ,references to title #ch1 ,united ,states ,code4 ,,title ,i--,developing an integrated high-performing network ,subtitle ,a--,establishing the ,veterans ,community ,care ,program ,sec4 #aja4 ,establishment of ,veterans ,community ,care ,program4 ,sec4 #ajb4 ,strategy regarding the ,high ,performing ,integrated ,healthcare ,network of the ,department4 ,sec4 #ajc4 ,access standards and standards for quality4 ,subtitle ,b--,forming partnerships and agreements ,sec4 #aaa4 ,continuity of care and existing agreements4 ,sec4 #aab4 ,authorization of agreements between ,department of ,veterans ,affairs and non-,department providers4 ,sec4 #aac4 ,prevention of certain health care providers from providing non-,department health care services to veterans4 ,sec4 #aad4 ,conforming amendments for ,state veterans homes4 ,subtitle ,c--,paying providers ,sec4 #aba4 ,prompt payment to providers4 ,sec4 #abb4 ,payment rates for community care4 ,sec4 #abc4 ,authority to pay for authorized care not subject to an agreement4 ,,title ,,ii--,streamlining community care programs ,subtitle ,a--,streamlining community care programs ,sec4 #bja4 ,access to walk-in care4 ,sec4 #bjb4 ,veterans ,choice ,fund flexibility4 ,sec4 #bjc4 ,conforming amendments4 ,subtitle ,b--,improving information sharing with providers ,sec4 #baa4 ,improving information sharing with community providers4 ,sec4 #bab4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers4 ,subtitle ,c--,improving collections ,sec4 #bba4 ,aligning with best practices on collection of health insurance information4 ,sec4 #bbb4 ,improving authority to collect4 ,,title ,,iii--,improving ,department of ,veterans ,affairs care delivery ,subtitle ,a--,improving personnel practices ,sec4 #cja4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine4 ,sec4 #cjb4 ,graduate medical education and residency4 ,sec4 #cjc4 ,annual report on awards or bonuses awarded to certain high-level employees of the department of veterans affairs4 ,subtitle ,b--,facilities1 construction1 and leases ,sec4 #caa4 ,facilitating sharing of medical facilities with other ,federal agencies4 ,sec4 #cab4 ,review of enhanced use leases4 ,,title ,,iv--,innovative pilot programs ,sec4 #dja4 ,pilot program to establish or affiliate with graduate medical residency programs at facilities operated by ,indian tribes1 tribal organizations1 and the ,indian ,health ,service in rural areas4 ,sec4 #djb4 ,authority for ,department of ,veterans ,affairs ,center for ,innovation for ,care and ,payment4 ,,title ,v--,other health care matters ,sec4 #eja4 ,authorization of appropriations for health care from ,department of ,veterans ,affairs4 ,sec4 #ejb4 ,appropriation of amounts for ,veterans ,choice ,program4 ,sec4 #ejc4 ,applicability of ,directive of ,office of ,federal ,contract ,compliance ,programs4 ,sec4 #ejd4 ,amending statutory requirements for the position of the ,chief ,officer of the ,readjustment ,counseling ,service4 ,sec4 #eje4 ,authorization of certain major medical facility projects of the ,department of ,veterans ,affairs4 #b4 ,references to title #ch1 ,united ,states ,code ,except as otherwise expressly provided1 whenever in this ,act an amendment or repeal is expressed in terms of an amendment to1 or repeal of1 a section or other provision1 the reference shall be considered to be made to a section or other provision of title #ch1 ,united ,states ,code4 ,i ,developing an integrated high-performing network ,a ,establishing the ,veterans ,community ,care ,program #aja4 ,establishment of ,veterans ,community ,care ,program 7a7 ,establishment 7#a7 ,in general ,section #agjc is amended to read as follows3 #agjc4 ,veterans ,community ,care ,program 7a7 ,in general 7#a7 ,subject to the availability of appropriations for such purpose and subject to paragraph 7#d71 hospital care1 medical services1 and extended care services under this chapter shall be furnished to a covered veteran described in subsection 7b7 by health care providers specified in subsection 7c7 in accordance with this section4 7#b7 ,the furnishing of care and services under this section may be referred to as the ,veterans ,community ,care ,program4 7#c7 7,a7 ,in carrying out this section1 the ,secretary may develop categories of certain health care providers specified in subsection 7c7 for the purpose of providing a covered veteran hospital care1 medical services1 and extended care services when the covered veteran does not state a preference for a health care provider4 7,b7 ,in developing categories of health care providers under subparagraph 7,a71 the ,secretary shall not-- 7i7 prioritize or rank such categories in a manner that limits the options a covered veteran may have in selecting a health care provider specified in subsection 7c72 or 7ii7 direct a covered veteran to receive care or services from certain health care providers instead of other health care providers4 7#d7 ,in carrying out this section1 the ,secretary shall not limit any hospital care1 medical service1 extended care service1 or class of hospital care1 medical service1 or extended care service that are set forth in the ,medical ,benefits ,package of the ,department1 as modified as determined by the ,secretary4 7b7 ,covered veterans ,for purposes of this section1 a covered veteran is any veteran who-- 7#a7 7,a7 is enrolled in the patient enrollment system of the ,department established and operated under section #agje of this title2 or 7,b7 is not enrolled in such system but is otherwise entitled to hospital care1 a medical service1 or an extended care service under subsection 7c77#b7 of such section2 and 7#b7 7,a7 has been furnished hospital care or medical services under this chapter on at least one occasion during the preceding two-year period2 or 7,b7 requested a first-time appointment for hospital care or medical services at a ,department facility4 7c7 ,health care providers specified ,health care providers specified in this subsection are the following3 7#a7 ,any health care provider that is participating in the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 including any physician furnishing services under such a program4 7#b7 ,the ,department of ,defense4 7#c7 ,the ,indian ,health ,service4 7#d7 ,any ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b7774 7#e7 ,any health care provider not otherwise covered under any of paragraphs 7#a7 through 7#d7 that meets criteria established by the ,secretary for purposes of this section4 7d7 ,contracts ,to establish networks of health care providers 7#a7 ,the ,secretary shall enter into consolidated1 competitively bid contracts1 which may be regional contracts1 to establish networks of non-,department health care providers specified in paragraphs 7#a7 and 7#e7 of subsection 7c7 for contract purposes of-- 7,a7 providing sufficient access to hospital care1 medical services1 and extended care services under this section2 7,b7 managing the operations of such health care providers2 and 7,c7 managing the delivery of hospital care1 medical services1 and extended care services under this section4 7#b7 ,the ,secretary may terminate a contract with an entity entered into under paragraph 7#a7 at such time and upon such notice to the entity as the ,secretary may specify for purposes of this section4 7#c7 7,a7 ,whenever the ,secretary provides notice to an entity under paragraph 7#b7 that the entity is failing to meet contractual obligations entered into under paragraph 7#a71 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 such failure and the decision of the ,secretary to terminate the contract under paragraph 7#b74 7,b7 ,each report submitted under subparagraph 7,a7 shall include the following3 7i7 ,an explanation of the reasons for terminating the contract4 7ii7 ,a description of the effect of the failure of the entity to meet contractual obligations and the termination of the contract1 including with respect to cost1 schedule1 and requirements4 7iii7 ,a description of the actions taken by the ,secretary to mitigate such failure and termination4 7e7 ,coordination of care and services 7#a7 ,the ,secretary shall ensure that for each covered veteran seeking care or services under this section1 a care coordination team is provided by a medical facility of the ,department4 7#b7 ,the ,secretary shall ensure that each care coordination team provided under this section1 with respect to a covered veteran1 is responsible for the following3 7,a7 ,coordination and management of hospital care1 medical services 7including telemedicine71 and extended care services furnished under this title1 including the following3 7i7 ,collaboration with the patient aligned care teams 7,,pact7 within the medical facility of the ,department2 and 7ii7 ,coordination within and across ,veterans ,integrated ,service ,networks with non-,department health care providers acting under a contract or agreement to furnish hospital care1 a medical service1 or an extended care service on behalf of the ,department and who meets such terms and conditions as the ,secretary may require4 7,b7 ,ensure continuity of care for the covered veteran to avoid any delay or lapse in care or services from an action or error of the ,department or any individual of the care coordination team of the covered veteran4 7,c7 ,submitting information to the ,secretary in furtherance of analysis conducted under section #agcj;,b7a7 of this title4 7#c7 ,the ,secretary shall develop an organizational construct for care coordination teams at medical facilities of the ,department that may include the following individuals3 7,a7 ,an employee of the ,department who furnishes hospital care1 a medical service1 or an extended care service at the facility4 7,b7 ,a non-,department health care provider acting under a contract or agreement to furnish hospital care1 a medical service1 or an extended care service on behalf of the ,department and who meets such terms and conditions as the ,secretary may require4 7,c7 ,an employee of the ,department or a health care provider described in subparagraph 7,b7 who serves to seamlessly coordinate the delivery of hospital care1 medical services1 and extended care services to covered veterans4 7f7 ,eligibility reform and conditions that require access to community care 7#a7 ,subject to the availability of appropriations1 the ,secretary shall furnish hospital care1 medical services1 and extended care services to a covered veteran1 at the election of a covered veteran1 through health care providers specified in subsection 7c7 as follows3 7,a7 ,when a medical facility of the ,department does not offer the hospital care1 medical services1 or extended care services the covered veteran requires4 7,b7 ,when a medical facility of the ,department cannot furnish or schedule an appointment for hospital care1 medical services1 or extended care services in accordance with access standards established under section #agjc;,b of this title4 7,c7 ,when the covered veteran and a referring clinician of the covered veteran agree that furnishing hospital care1 medical services1 or extended care services through a non-,department entity or provider would be in the best medical interest of the covered veteran1 after consideration of the standards established under sections #agjc;,b and #agjc;,c of this title or due to a non-clinical reason1 compelling circumstance1 or other considerations that are in the best medical interest of the covered veteran4 7#b7 ,not later than #abj days after the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag1 the ,secretary shall submit to the appropriate committees of ,congress a report describing the guidelines and standards the ,secretary intends to use to carry out paragraph 7#a7 in accordance with sections #agjc;,b and #agjc;,c of this title4 7g7 ,scheduling services 7#a7 ,the ,secretary shall ensure that services are established in order to schedule appointments for hospital care1 medical services1 and extended care services under this chapter4 7#b7 7,a7 ,in carrying out paragraph 7#a71 the ,secretary shall determine whether services established under such paragraph should reside within the respective medical facility of the ,department or reside with an entity with whom the ,secretary enters into a contract for such services4 7,b7 ,in carrying out subparagraph 7,a71 the ,secretary shall assess the following3 7i7 ,whether a medical facility of the ,department is currently managing scheduling services and the ,secretary determines such medical facility has the capability to continue to manage scheduling4 7ii7 ,whether a medical facility of the ,department has the capacity to manage scheduling services based on the following3 7,i7 ,an initial review of the medical facility to acquire scheduling service responsibilities and the preference of the medical facility to acquire such responsibilities4 7,,ii7 ,the market area assessment currently underway pursuant to section #agcj;,b7c7 of this title4 7,,iii7 ,the capacity of the medical facility to perform scheduling services that meet standards established under sections #agjc;,b and #agjc;,c of this title4 7iii7 ,whether one or more contracts were in effect on the day before the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag that include scheduling services1 as determined by the ,secretary1 and may be modified by the ,secretary for services under this subsection4 7h7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term clinician has the meaning given that term by the ,centers for ,medicare ,medicaid ,services and includes ,doctors of ,medicine 7,,md71 ,doctors of ,osteopathy 7,,do71 ,doctors of ,dental ,surgery or ,dental ,medicine 7,,dmd_/,,dds71 ,doctors of ,podiatry1 ,doctors of ,optometry1 ,chiropractors1 ,physician ,assistants 7,,pa71 ,nurse ,practitioners 7,,np71 ,clinical ,nurse ,specialists1 ,certified ,registered ,nurse ,anesthetists1 and such other health professionals as the ,secretary may specify for purposes of this section4 7#c7 ,the term medical facility of the ,department includes a medical center1 a community-based outpatient clinic1 an outpatient clinic1 or any other facility of the ,department at which hospital care1 medical services1 or extended care services are furnished4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by striking the item relating to section #agjc and inserting the following new item3 #agjc4 ,veterans ,community ,care ,program4 4 7b7 ,regulations ,not later than one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall promulgate regulations to carry out section #agjc of title #ch1 ,united ,states ,code1 as amended by subsection 7a74 7c7 ,effective date ,the amendments made by subsection 7a7 shall take effect on the date that the ,secretary promulgates regulations under subsection 7b74 #ajb4 ,strategy regarding the ,high ,performing ,integrated ,healthcare ,network of the ,department 7a7 ,in general ,subchapter ,,iii of chapter #ag is amended by inserting after section #agcj;,a the following new section3 #agcj;,b4 ,quadrennial ,veterans ,health ,administration review1 management of high-performing integrated healthcare network1 and market area assessments 7a7 ,quadrennial ,veterans ,health ,administration review 7#a7 ,not later than one year after the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag and not less frequently than once every four years thereafter1 the ,secretary shall conduct a comprehensive examination 7to be known as a quadrennial ,veterans ,health ,administration review7 of programs and policies of the ,department regarding the delivery of health care services and the need for health care services for veterans in future years4 7#b7 ,the ,secretary shall designate an individual in a ,senior ,executive ,service position 7as defined in section #cacb7;a7 of title #e7 or equivalent as the ,director of the ,high-,performing ,integrated ,healthcare ,network of the ,department 7in this section referred to as the ,director7 who shall be responsible for carrying out this section and advising the ,secretary and the ,under ,secretary for ,health on matters pertaining to this section4 7#c7 ,each quadrennial ,veterans ,health ,administration review conducted under paragraph 7#a7 shall include a strategic plan to meet future requirements and demand for hospital care1 medical services1 and extended care services under the laws administered by the ,secretary that includes a five-year budget forecast for meeting such requirements and demand based on the information contained in the market area assessments conducted under subsection 7c7 and such other information as the ,secretary considers appropriate4 7#d7 ,in preparing the quadrennial ,veterans ,health ,administration review under paragraph 7#a71 including the strategic plan under paragraph 7#c71 the ,secretary shall-- 7,a7 consider the access and quality standards established under sections #agjc;,b and #agjc;,c of this title1 respectively2 7,b7 consider the needs of the ,department to furnish health care services to veterans based on-- 7i7 identified health care services that provide management of health conditions or disorders related to military service for which there is limited experience or access to such health care services from non-,department health care providers in the commercial market2 7ii7 the overall health of veterans throughout their lifespan2 or 7iii7 such other services as the ,secretary determines appropriate2 7,c7 consult with key stakeholders within the ,department1 the heads of other ,federal agencies1 and other relevant governmental and nongovernmental entities1 including ,state1 local1 and tribal government officials1 members of ,congress1 veterans service organizations1 private sector representatives1 academics1 and other policy experts2 7,d7 identify emerging issues1 trends1 problems1 and opportunities that could affect health care services furnished under the laws administered by the ,secretary2 7,e7 develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the ,secretary2 7,f7 compare the ,veterans ,equitable ,resource ,allocation 7,,vera7 system to other resource allocation systems or models for the purpose of analyzing the effectiveness of such systems in allocating resources to furnish hospital care1 medical services1 and extended care services to veterans2 and 7,g7 consider the work of the ,center for ,innovation for ,care and ,payment under section #agjc;,f of this title with respect to research1 development1 and testing payment and service delivery models4 7b7 ,management of high-,performing integrated healthcare network 7#a7 ,the ,director shall be responsible for the management1 design1 implementation1 and assessment of the high-performing integrated healthcare network of the ,department4 7#b7 ,in managing1 designing1 implementing1 and assessing the high-performing integrated healthcare network of the ,department under this subsection1 the ,director shall be responsible for the following3 7,a7 ,overseeing the transformation and organizational change across the ,department to achieve such high-performing integrated healthcare network4 7,b7 ,developing and implementing the quadrennial ,veterans ,health ,administration review and strategic plan under subsection 7a74 7,c7 ,overseeing the market area assessments performed under subsection 7c74 7,d7 ,developing the capital infrastructure planning and procurement processes1 whether minor or major construction projects or leases1 in coordination with other offices of the ,department4 7,e7 ,developing a multi-year budget process that is capable of forecasting future year budget requirements and projecting the cost of delivering health care services under a high-performing integrated healthcare network4 7#c7 ,to ensure that the ,director is able to carry out the responsibilities under paragraph 7#b71 the ,secretary shall ensure that coordination and information sharing occurs with other relevant offices of the ,department1 including the following offices3 7,a7 ,the ,office of ,management4 7,b7 ,the ,office of ,acquisition1 ,logistics and ,construction4 7,c7 ,the ,office of ,information and ,technology4 7#d7 ,in carrying out this subsection1 the ,director shall confer with the ,director of the ,defense ,health ,agency and consider best practices and recommendations from non-,department entities1 including entities carrying out market area assessments under subsection 7c71 that have developed plans1 implemented systems1 or advised other healthcare systems4 7#e7 7,a7 ,not less frequently than once every three months1 the ,secretary or the ,director shall brief the appropriate committees of ,congress on the activities conducted under this subsection4 7,b7 ,each briefing conducted under subparagraph 7,a7 shall include the following3 7i7 ,an assessment of any remediation or improvement conducted by the ,department with respect to a medical service line of the ,department that the ,secretary has determined does not meet an access standard or standard for quality established under section #agjc;,b or #agjc;,c of this title1 respectively1 in providing hospital care1 a medical service1 or an extended care service1 including the following3 7,i7 ,an assessment of the factors that led the ,secretary to make such determination4 7,,ii7 ,an assessment of the medical service line in relation to the market area assessment most recently performed under subsection 7c71 particularly with respect to how it relates to the demand for the medical service line in the area and by veterans using a medical facility of the ,department for such medical service line4 7,,iii7 ,a plan with specific actions1 and the time to complete them1 to meet the access standards and standards for quality established under sections #agjc;,b and #agjc;,c of this title1 respectively1 which shall include consideration of-- 7aa7 increasing personnel or temporary personnel assistance1 including mobile deployment teams2 7bb7 special hiring incentives1 including the ,education ,debt ,reduction ,program under subchapter ,,vii of chapter #gf of this title and recruitment1 relocation1 and retention incentives2 7cc7 using direct hiring authority2 7dd7 providing improved training opportunities for staff2 7ee7 acquiring improved equipment2 7ff7 making structural modifications to the facility used by the medical service line2 7gg7 partnering with health care providers that have the capacity to meet the demand in the market area and meet access and quality standards established under sections #agjc;,b and #agjc;,c of this title2 and 7hh7 such other actions as the ,secretary considers appropriate4 7ii7 ,an assessment of the progress made by the ,department with respect to the responsibilities of the ,director under paragraph 7#b74 7c7 ,market area assessments 7#a7 ,not less frequently than once every four years1 the ,secretary shall perform market area assessments regarding the health care services furnished under the laws administered by the ,secretary4 7#b7 ,each market area assessment performed under paragraph 7#a7 shall include the following3 7,a7 ,an assessment of the demand for hospital care1 medical services1 and extended care services from the ,department1 disaggregated by geographic market areas that are consistent with industry market areas or boundaries1 including the number of requests for such care and services under the laws administered by the ,secretary4 7,b7 ,an inventory of the health care capacity of the ,department across the facilities of the ,department4 7,c7 ,an assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the ,department under section #agjc;,a of this title1 including the number of providers1 the geographic location of the providers1 and categories or types of health care services provided by the providers4 7,d7 ,an assessment obtained from other ,federal direct delivery systems of their capacity to provide health care to veterans4 7,e7 ,an assessment of the health care capacity of non-contracted providers where there is insufficient network supply4 7,f7 ,an assessment of the health care capacity of academic affiliates and other collaborations of the ,department as it relates to providing health care to veterans4 7,g7 ,an assessment of the effects on health care capacity by the access and quality standards established under sections #agjc;,b and #agjc;,c of this title1 respectively4 7,h7 ,the number of appointments for health care services under the laws administered by the ,secretary1 disaggregated by-- 7i7 appointments at facilities of the ,department2 and 7ii7 appointments with non-,department health care providers4 7,i7 ,analysis of information submitted from care coordination teams under section #agjc7;e77#b77;,d7 of this title from each ,department medical facility that includes the following3 7i7 ,an analysis of coordination and management best practices4 7ii7 ,satisfaction survey data from the covered veterans from each care coordination team under section #agjc7;e7 of this title4 7iii7 ,findings and determinations related to the coordination of care under section #agjc7;e7 of this title to assist the ,director in the design1 implementation1 and assessment of the high-performing integrated healthcare network of the ,department4 7iv7 ,a standardized climate survey developed jointly with the ,centers for ,medicare ,medicaid ,services ,alliance to ,modernize ,healthcare 7,,camh7 for the employees of each medical facility of the ,department that compiles data on culture1 communication1 teamwork1 quality of worklife1 rewards or recognition1 leadership1 and productivity4 7#c7 ,the ,secretary shall submit to the appropriate committees of ,congress each market area assessment performed under paragraph 7#a7 and the complete market area assessment being performed on the day before the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag in the same form as such assessments are delivered to the ,secretary4 7#d7 ,the ,secretary shall use the market area assessments performed under paragraph 7#a7 to inform the quadrennial ,veterans ,health ,administration review and strategic plan under subsection 7a7 and to determine the capacity of the ,department and the capacity of the health care provider networks established under section #agjc7;d7 of this title4 7#e7 ,the ,secretary shall publish the capacity findings and results from the market area assessments performed under paragraph 7#a7 with respect to the ,department and health care provider networks established under section #agjc7;d7 of this title on a publicly accessible ,internet website of the ,department4 7d7 ,department budget ,the ,secretary shall ensure that the budget request of the ,department for any fiscal year 7as submitted with the budget of the ,president under section #aaje7;a7 of title #ca7 reflects the findings of the ,secretary with respect to the most recent information described in subsection 7b77#e7 and is consistent with the quadrennial ,veterans ,health ,administration review and strategic plan under subsection 7a74 7e7 ,appropriate committees of ,congress defined ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag is amended by inserting after the item relating to section #agcj;,a the following new item3 #agcj;,b4 ,quadrennial ,veterans ,health ,administration review1 management of high-performing integrated healthcare network1 and market area assessments4 4 7c7 ,waiver of certain requirements for market assessment in progress ,paragraph 7#b7 of section #agcj;,b7c7 of title #ch1 ,united ,states ,code1 as added by subsection 7a71 shall not apply to a market area assessment that was being performed by the ,secretary of ,veterans ,affairs on the day before the date of the enactment of this ,act4 #ajc4 ,access standards and standards for quality 7a7 ,in general ,subchapter ,i of chapter #ag is amended by inserting after section #agjc the following new sections3 #agjc;,b4 ,access standards 7a7 ,in general 7#a7 ,the ,secretary shall establish access standards for hospital care1 medical services1 and extended care services furnished by the ,department1 including through health care providers under section #agjc of this title4 7#b7 ,the ,secretary shall ensure that the hospital care1 medical services1 and extended care services furnished to a veteran by the ,department1 including through health care providers under section #agjc of this title1 is furnished within the access standards established under paragraph 7#a74 7#c7 ,the access standards established under paragraph 7#a7 shall align with the categories of hospital care1 medical services1 and extended care services set forth under subsection 7b7 and shall be informed by the market area assessments performed under section #agcj;,b7c7 of this title4 7b7 ,categories of hospital care1 medical services1 and extended care services furnished ,the categories of hospital care1 medical services1 and extended care services subject to access standards established under subsection 7a7 are as follows3 7#a7 ,primary care services4 7#b7 ,specialty care services1 including services that may require a referral and services that may be considered wellness or preventative care4 7#c7 ,behavioral health services1 including mental health and substance abuse disorder treatment4 7#d7 ,urgent care4 7#e7 ,home health services1 including services that may be virtual4 7#f7 ,dental services4 7#g7 ,as determined by the ,secretary1 any additional types of services for which the ,department or the networks established under section #agjc7;d7 of this title have experienced increased demand according to the market area assessments performed under section #agcj;,b7c7 of this title or an increase in access complaints to network health care providers or the ,department4 7c7 ,application 7#a7 ,the ,secretary may establish and apply access standards under subsection 7a7 according to the market area assessments under section #agcj;,b7c7 of this title4 7#b7 ,in carrying out section #agjc of this title1 the ,secretary shall apply access standards established under subsection 7a7 to a covered veteran under such section with respect to the residence1 as defined in section #ag4aeje of title #ch1 ,code of ,federal ,regulations 7or any successor regulation71 of the covered veteran4 7d7 ,comparative information ,the ,secretary shall ensure that the access standards required by subsection 7a7 provide veterans1 employees of the ,department1 and health providers in the ,veterans ,community ,care ,program established under section #agjc of this title with relevant comparative information that is clear1 useful1 and timely1 so that veterans can make informed and responsible decisions regarding their hospital care1 medical services1 and extended care services4 7e7 ,coordination ,the ,secretary shall coordinate with the ,secretary of ,defense1 and may consult with the ,secretary of ,health and ,human ,services1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 entities in the private sector1 and other nongovernmental entities in establishing access standards under subsection 7a74 7f7 ,periodic review ,not later than two years after the date on which the ,secretary establishes access standards under this section and not less frequently than once every three years thereafter1 the ,secretary shall-- 7#a7 conduct a review of such standards2 and 7#b7 submit to the appropriate committees of ,congress a report that includes the following3 7,a7 ,a report on the findings of the ,secretary with respect to the review conducted under paragraph 7#a7 and any modification to such standards as the ,secretary considers appropriate4 7,b7 ,for each medical service line that the ,secretary determined1 during the period covered by the report1 did not meet a standard established under this section1 identification of the leadership team in the facility and the ,veterans ,integrated ,service ,network that are responsible for overseeing the progress of the medical service line in meeting such standard4 7g7 ,publication ,the ,secretary shall publish the health care access standards established under subsection 7a7 and any modifications to such standards in the ,federal ,register and on a publicly accessible ,internet website of the ,department4 7h7 ,appropriate committees of congress defined ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 #agjc;,c4 ,standards for quality 7a7 ,in general 7#a7 ,the ,secretary shall establish standards for quality regarding hospital care1 medical services1 and extended care services furnished by the ,department1 including through health care providers under section #agjc of this title4 7#b7 ,the ,secretary shall ensure that the hospital care1 medical services1 and extended care services furnished to a veteran by the ,department1 including through health care providers under section #agjc of this title1 is furnished within the standards for quality established under paragraph 7#a74 7#c7 ,the standards for quality established under paragraph 7#a7 shall align with the ,department of ,defense according to categories of hospital care1 medical services1 and extended care services set forth under section #agjc;,b7b7 of this title and shall be informed by the market area assessments performed under section #agcj;,b7c7 of this title4 7#d7 ,in establishing standards for quality under paragraph 7#a71 the ,secretary shall-- 7,a7 conduct a survey of covered veterans described in section #agjc7;b7 of this title through a third party entity to assess the satisfaction of such veterans with service and quality of care2 and 7,b7 collect data sets that include1 at a minimum-- 7i7 general information2 7ii7 surveys of patients' experiences2 7iii7 timely and effective care2 7iv7 complications2 7v7 readmissions and deaths2 7vi7 use of medical imaging2 7vii7 payment and value of care2 and 7viii7 use of telemedicine4 7#e7 ,the ,secretary shall develop such standards for quality and collect data according to health care settings consistent with the ,department of ,defense and the ,centers for ,medicare ,medicaid ,services1 including1 at a minimum1 the following3 7,a7 ,inpatient hospitals4 7,b7 ,nursing homes4 7,c7 ,individual health care providers4 7,d7 ,dialysis facilities4 7,e7 ,hospice4 7,f7 ,inpatient rehabilitation facilities4 7,g7 ,long-term care hospitals4 7,h7 ,outpatient facilities4 7#f7 ,the standards for quality established under paragraph 7#a7 shall be informed by existing health quality measures1 such as those defined by the ,health,care ,effectiveness ,data and ,information ,set1 that are applied to public and privately sponsored health care systems with the purpose of providing veterans relevant comparative information to make informed decisions regarding their health care4 7b7 ,improving and strengthening quality standards ,not later than one year after the date on which the ,secretary establishes standards under subsection 7a71 the ,secretary shall-- 7#a7 publish the quality rating of medical facilities of the ,department on a publicly available ,internet website1 such as a website of the ,centers for ,medicare ,medicaid ,services1 for the purpose of providing veterans with information that allows them to compare performance measure information among ,department and community health care providers who provide hospital care1 medical services1 or extended care services under section #agjc of this title2 and 7#b7 consider and solicit public comment on potential changes to the established quality measures to ensure that they include the most up-to-date and applicable industry measures for veterans4 7c7 ,coordination ,the ,secretary shall coordinate with the ,secretary of ,defense1 and may consult with the ,secretary of ,health and ,human ,services1 the ,administrator of the ,centers for ,medicare ,medicaid ,services1 entities in the private sector1 and other nongovernmental entities in establishing standards for quality under this section4 7d7 ,periodic review ,not later than two years after the date on which the ,secretary establishes standards for quality under this section and not less frequently than once every three years thereafter1 the ,secretary shall-- 7#a7 conduct a review of such standards across the ,department2 and 7#b7 submit to the appropriate committees of ,congress a report that includes the following3 7,a7 ,a report on the findings of the ,secretary with respect to the review conducted under paragraph 7#a7 and any modification to such standards as the ,secretary considers appropriate4 7,b7 ,for each medical service line that the ,secretary determined1 during the period covered by the report1 did not meet a standard established under this section1 identification of the leadership team in the facility and the ,veterans ,integrated ,service ,network that are responsible for overseeing the progress of the medical service line in meeting such standard4 7e7 ,publication ,the ,secretary shall publish the health care quality standards established under subsection 7a7 and any modifications to such standards in the ,federal ,register and on a publicly accessible ,internet website of the ,department4 7f7 ,appropriate committees of congress defined ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag1 as amended by section #ajb1 is further amended by inserting after the item relating to section #agjc the following new items3 #agjc;,b4 ,access standards4#agjc;,c4 ,standards for quality4 4 7c7 ,submittal of access standards and standards for quality 7#a7 ,in general ,not later than ,july #a1 #bjah1 the ,secretary of ,veterans ,affairs shall submit to the appropriate committees of ,congress a report detailing the access standards and standards for quality established under sections #agjc;,b and #agjc;,c of title #ch1 ,united ,states ,code1 respectively1 as added by subsection 7a74 7#b7 ,appropriate committees of ,congress defined ,in this subsection1 the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 ,b ,forming partnerships and agreements #aaa4 ,continuity of care and existing agreements 7a7 ,in general ,notwithstanding section #agjc of title #ch1 ,united ,states ,code1 as amended by section #aja of this ,act1 the ,secretary of ,veterans ,affairs shall ensure veterans do not experience a delay or lapse in care or services by continuing the following3 7#a7 ,all contracts1 memorandums of understanding1 and memorandums of agreements that were in effect on the day before the date of the enactment of this ,act between the ,department of ,veterans ,affairs and the ,american ,indian and ,alaska ,native health care systems as established under the auspices of the ,department of ,veterans ,affairs and ,indian ,health ,service ,memorandum of ,understanding1 signed ,october #a1 #bjaj4 7#b7 ,the ,national ,reimbursement ,agreement1 signed ,december #e1 #bjab4 7#c7 ,agreements that were in effect on the day before the date of the enactment of this ,act and entered into under section #aja1 #ajb1 or #ajc of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf74 7#d7 ,agreements that were in effect on the day before the date of the enactment of this ,act for the purpose of dialysis treatment1 only if the contracts or agreements established under section #agjc of title #ch1 ,united ,states ,code1 as amended by section #aja of this ,act1 do not stipulate that such treatments be furnished by providers under such contracts or agreements4 7b7 ,modifications ,subsection 7a7 shall not be construed to prohibit the ,secretary and the parties to the contracts1 agreements1 memorandums of understanding1 and memorandums of agreements described in such subsection from making such changes to such contracts1 agreements1 memorandums of understanding1 and memorandums of agreements as may be otherwise authorized pursuant to other provisions of law or the terms of the contracts1 agreements1 memorandums of understanding1 and memorandums of agreements4 7c7 ,treatment of existing contractors ,to the extent practicable1 the ,secretary shall give health care providers who are providing hospital care1 medical services1 or extended care services pursuant to a contract with the ,secretary under section #agjc of title #ch1 ,united ,states ,code1 as in effect on the day before the date of the enactment of this ,act1 the opportunity to furnish hospital care1 medical services1 or extended care services under such section as amended by section #aja of this ,act4 #aab4 ,authorization of agreements between ,department of ,veterans ,affairs and non-,department providers 7a7 ,in general ,subchapter ,i of chapter #ag1 as amended by sections #aja and #ajc1 is further amended by inserting after section #agjc the following new section3 #agjc;,a4 ,agreements with eligible entities or providers2 certification processes 7a7 ,agreements authorized 7#a7 7,a7 ,when hospital care1 a medical service1 or an extended care service is not available to a veteran described in section #agjc7;b7 of this title from a medical facility of the ,department or through a contract or sharing agreement entered into under this title under an authority other than this section1 the ,secretary may furnish such care or service to such veteran to avoid a delay or lapse in such care or service by entering into an agreement under this section with a health care provider specified in section #agjc7;c7 of this title to provide such care or service4 7,b7 ,an agreement entered into under this section to provide hospital care1 a medical service1 or an extended care service shall be known as a ,veterans ,care ,agreement4 7,c7 ,for purposes of subparagraph 7,a71 hospital care1 a medical service1 or an extended care service may be considered not available to a veteran from a medical facility of the ,department or through a contract or sharing agreement described in such subparagraph when the ,secretary determines the veteran's medical condition1 the travel involved1 the nature of the care or services required1 or a combination of these factors make the use of a facility of the ,department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable4 7,d7 ,a ,veterans ,care ,agreement may be entered into by the ,secretary or any ,department official authorized by the ,secretary4 7#b7 7,a7 ,subject to subparagraph 7,b71 the ,secretary shall review each ,veterans ,care ,agreement of material size1 as determined by the ,secretary or set forth in paragraph 7#c71 for hospital care1 a medical service1 or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the ,department or by contract or sharing agreement entered into pursuant to another provision of law and1 if so1 take action to do so4 7,b7 7i7 ,the ,secretary shall review each ,veterans ,care ,agreement of material size that has been in effect for at least six months within the first two years of its taking effect1 and no less frequently than once every four years thereafter4 7ii7 ,if a ,veterans ,care ,agreement has not been in effect for at least six months by the date of the review required by subparagraph 7,a71 the agreement will be reviewed during the next cycle required by subparagraph 7,a71 and such review will serve as its review within the first two years of its taking effect for purposes of clause 7i74 7#c7 ,in addition to such other ,veterans ,care ,agreements as the ,secretary may determine are of material size1 each ,veterans ,care ,agreement that takes effect after the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag shall be considered of material size4 7#d7 7,a7 ,the ,secretary1 and any other ,department official authorized by the ,secretary1 may enter into an agreement under this section for extended care services only if the ,secretary does not expect such agreement would result in an obligation of the ,department that exceeds a rate of #e1jjj1jjj annually4 7,b7 ,if the ,secretary enters into an agreement with a provider under this section and pursuant to the agreement the ,department incurs an obligation that exceeds an annual rate of1 with respect to extended care services1 the rate set forth in subparagraph 7,a71 and with respect to services that are not extended care services1 #b1jjj1jjj1 the ,secretary shall submit to the appropriate committees of ,congress notice that such obligation has exceeded such rate and an accounting of the cost and need for such agreement if such provider is unable or unwilling to enter into a contract or other agreement under section #agjc of this title4 7,c7 ,in this paragraph1 the term appropriate committees of ,congress means-- 7i7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7ii7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7b7 ,eligible entities and providers ,for purposes of this section1 an eligible entity or provider is-- 7#a7 any 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;cc7a77 and any physician or other supplier who has enrolled and entered into a participation agreement under section #ahdb7;h7 of such ,act 7#db ,u4,s4,c4 #acieu7h772 7#b7 any provider participating under a ,state plan under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 or 7#c7 any entity or provider not described in paragraph 7#a7 or 7#b7 of this subsection that the ,secretary determines to be eligible pursuant to the certification process described in subsection 7c74 7c7 ,eligible entity or provider certification process ,the ,secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section4 ,such a process shall1 at a minimum-- 7#a7 establish deadlines for actions on applications for certification2 7#b7 set forth standards for an approval or denial of certification1 duration of certification1 revocation of an eligible entity or provider's certification1 and recertification of eligible entities or providers2 7#c7 require the denial of certification if the ,secretary determines the eligible entity or provider is excluded from participation in a ,federal health care program under section #aabh or section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is currently identified as an excluded source on the ,system for ,award ,management ,exclusions list described in part #i of title #dh1 ,code of ,federal ,regulations1 and part #ahj of title #b of such ,code1 or successor regulations2 7#d7 establish procedures for screening eligible entities or providers according to the risk of fraud1 waste1 and abuse that are similar to the standards under section #ahff7;j77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7j77#b77;,b77 and section #i4ajd and subpart #i4d of title #dh1 ,code of ,federal ,regulations1 or successor regulations2 and 7#e7 incorporate and apply the restrictions and penalties set forth in chapter #ba of title #da and treat this section as a procurement program only for purposes of applying such provisions4 7d7 ,rates ,to the extent practicable1 the rates paid by the ,secretary for hospital care1 medical services1 and extended care services provided under a ,veterans ,care ,agreement shall be in accordance with the rates paid by the ,united ,states under the ,medicare program4 7e7 ,terms of ,veterans ,care ,agreements 7#a7 ,pursuant to regulations promulgated under subsection 7k71 the ,secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services1 the number of employees employed by the entity or provider furnishing such care or services1 the amount paid by the ,secretary to the provider or entity1 or other factors as determined by the ,secretary4 7#b7 ,to furnish hospital care1 medical services1 or extended care services under this section1 an eligible entity or provider shall agree-- 7,a7 to accept payment at the rates established in regulations prescribed under this section2 7,b7 that payment by the ,secretary under this section on behalf of a veteran to a provider of services or care shall1 unless rejected and refunded by the provider within #cj days of receipt1 constitute payment in full and extinguish any liability on the part of the veteran for the treatment or care provided1 and no provision of a contract1 agreement1 or assignment to the contrary shall operate to modify1 limit1 or negate this requirement2 7,c7 to provide only the care and services authorized by the ,department under this section and to obtain the prior written consent of the ,department to furnish care or services outside the scope of such authorization2 7,d7 to bill the ,department in accordance with the methodology outlined in regulations prescribed under this section2 7,e7 to not seek to recover or collect from a health plan contract or third party1 as those terms are defined in section #agbi of this title1 for any service for which payment is made by the ,department2 7,f7 to provide medical records to the ,department in the time frame and format specified by the ,department2 and 7,g7 to meet such other terms and conditions1 including quality of care assurance standards1 as the ,secretary may specify in regulation4 7f7 ,discontinuation or nonrenewal of a ,veterans ,care ,agreements 7#a7 ,an eligible entity or provider may discontinue a ,veterans ,care ,agreement at such time and upon such notice to the ,secretary as may be provided in regulations prescribed under this section4 7#b7 ,the ,secretary may discontinue a ,veterans ,care ,agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section1 if an official designated by the ,secretary-- 7,a7 has determined that the eligible entity or provider failed to comply substantially with the provisions of the ,veterans ,care ,agreement1 or with the provisions of this section or regulations prescribed under this section2 7,b7 has determined the eligible entity or provider is excluded from participation in a ,federal health care program under section #aabh or section #aabh;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g or #acbj;a-#g;a7 or is identified on the ,system for ,award ,management ,exclusions list as provided in part #i of title #dh1 ,code of ,federal ,regulations1 and part #ahj of title #b of such ,code1 or successor regulations2 7,c7 has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under ,federal or ,state law and determines the eligible entity or provider's continued participation would be detrimental to the best interests of veterans or the ,department2 or 7,d7 has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran4 7g7 ,quality of care ,the standards for quality established under section #agjc;,c of this title shall be applied in monitoring the quality of care provided to veterans through ,veterans ,care ,agreements and for assessing the quality of hospital care1 medical services1 and extended care services furnished by eligible entities and providers before the renewal of ,veterans ,care ,agreements4 7h7 ,disputes 7#a7 ,the ,secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to ,veterans ,care ,agreements4 7#b7 ,such procedures constitute the eligible entities' and providers' exhaustive and exclusive administrative remedies4 7#c7 ,eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section #acdf of title #bh 7known as the ,tucker ,act74 7#d7 ,disputes under this section must pertain to either the scope of authorization under the ,veterans ,care ,agreement or claims for payment subject to the ,veterans ,care ,agreement and are not claims for the purposes of such laws that would otherwise require application of sections #gaja through #gaji of title #da1 ,united ,states ,code4 7i7 ,applicability of other provisions of law 7#a7 ,a ,veterans ,care ,agreement may be authorized by the ,secretary or any ,department official authorized by the ,secretary1 and such action is not an award for the purposes of such laws that would otherwise require the use of competitive procedures for furnishing of care and services4 7#b7 7,a7 ,except as provided in subparagraph 7,b71 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 an eligible entity or provider that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7,b7 ,an eligible entity or provider that enters into an agreement under this section is subject to-- 7i7 all laws regarding integrity1 ethics1 or fraud1 or that subject a person to civil or criminal penalties2 and 7ii7 all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities4 7j7 ,parity of treatment ,eligibility for hospital care1 medical services1 and extended care services furnished to any veteran pursuant to a ,veterans ,care ,agreement shall be subject to the same terms as though provided in a facility of the ,department1 and provisions of this chapter applicable to veterans receiving such care and services in a facility of the ,department shall apply to veterans treated under this section4 7k7 ,rulemaking ,the ,secretary shall promulgate regulations to carry out this section4 4 7b7 ,clerical ,amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item related to section #agjc the following new item3 #agjc;,a4 ,agreements with eligible entities or providers2 certification processes4 4 #aac4 ,prevention of certain health care providers from providing non-,department health care services to veterans 7a7 ,in general ,on and after the date that is one year after the date of the enactment of this ,act1 the ,secretary of ,veterans ,affairs shall deny or revoke the eligibility of a health care provider to provide non-,department health care services to veterans if the ,secretary determines that the health care provider-- 7#a7 was removed from employment with the ,department of ,veterans ,affairs due to conduct that violated a policy of the ,department relating to the delivery of safe and appropriate health care2 or 7#b7 violated the requirements of a medical license of the health care provider that resulted in the loss of such medical license4 7b7 ,permissive action ,on and after the date that is one year after the date of the enactment of this ,act1 the ,secretary may deny1 revoke1 or suspend the eligibility of a health care provider to provide non-,department health care services if the ,secretary determines such action is necessary to immediately protect the health1 safety1 or welfare of veterans and the health care provider is under investigation by the medical licensing board of a ,state in which the health care provider is licensed or practices4 7c7 ,suspension ,the ,secretary shall suspend the eligibility of a health care provider to provide non-,department health care services to veterans if the health care provider is suspended from serving as a health care provider of the ,department4 7d7 ,comptroller ,general report ,not later than two years after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to ,congress a report on the implementation by the ,secretary of this section1 including the following3 7#a7 ,the aggregate number of health care providers denied or suspended under this section from participation in providing non-,department health care services4 7#b7 ,an evaluation of any impact on access to health care for patients or staffing shortages in programs of the ,department providing non-,department health care services4 7#c7 ,an explanation of the coordination of the ,department with the medical licensing boards of ,states in implementing this section1 the amount of involvement of such boards in such implementation1 and efforts by the ,department to address any concerns raised by such boards with respect to such implementation4 7#d7 ,such recommendations as the ,comptroller ,general considers appropriate regarding harmonizing eligibility criteria between health care providers of the ,department and health care providers eligible to provide non-,department health care services4 7e7 ,non-,department health care services defined ,in this section1 the term non-,department health care services means hospital care1 medical services1 and extended care services furnished at non-,department facilities under chapter #ag of title #ch1 ,united ,states ,code4 #aad4 ,conforming amendments for ,state veterans homes 7a7 ,in general ,section #agde7;a7 is amended-- 7#a7 in paragraph 7#a71 by striking 7or agreement under section #agbj7;c77#a7 of this title7 and inserting 7or an agreement72 and 7#b7 by adding at the end the following new paragraph3 7#d7 7,a7 ,an agreement under this section may be authorized by the ,secretary or any ,department official authorized by the ,secretary1 and any such action is not an award for purposes of such laws that would otherwise require the use of competitive procedures for the furnishing of hospital care1 medical services1 and extended care services4 7,b7 7i7 ,except as provided in clause 7ii71 and unless otherwise provided in this section or regulations prescribed pursuant to this section1 a ,state home that enters into an agreement under this section is not subject to1 in the carrying out of the agreement1 any provision of law to which providers of services and suppliers under the ,medicare program under title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 are not subject4 7ii7 ,a ,state home that enters into an agreement under this section is subject to-- 7,i7 all provisions of law regarding integrity1 ethics1 or fraud1 or that subject a person to civil or criminal penalties2 and 7,,ii7 all provisions of law that protect against employment discrimination or that otherwise ensure equal employment opportunities4 7iii7 ,notwithstanding subparagraph 7,b77ii77,i71 a ,state home that enters into an agreement under this section may not be treated as a ,federal contractor or subcontractor for purposes of chapter #fg of title #da 7known as the ,mc,namara-,o',hara ,service ,contract ,act of #aife74 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall apply to care provided on or after the effective date of regulations issued by the ,secretary of ,veterans ,affairs to carry out this section4 ,c ,paying providers #aba4 ,prompt payment to providers 7a7 ,in general ,subchapter ,i of chapter #ag is amended by inserting after section #agjc;,c1 as added by section #ajc of this ,act1 the following new section3 #agjc;,d4 ,prompt payment standard 7a7 ,in general 7#a7 ,notwithstanding any other provision of this title or of any other provision of law1 the ,secretary shall pay for hospital care1 medical services1 or extended care services furnished by health care entities or providers under this chapter within #de calendar days upon receipt of a clean paper claim or #cj calendar days upon receipt of a clean electronic claim4 7#b7 ,if a claim is denied1 the ,secretary shall1 within #de calendar days of denial for a paper claim and #cj calendar days of denial for an electronic claim1 notify the health care entity or provider of the reason for denying the claim and what1 if any1 additional information is required to process the claim4 7#c7 ,upon the receipt of the additional information1 the ,secretary shall ensure that the claim is paid1 denied1 or otherwise adjudicated within #cj calendar days from the receipt of the requested information4 7#d7 ,this section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers4 7b7 ,submittal of claims by health care entities and providers ,a health care entity or provider that furnishes hospital care1 medical services1 or extended care services under this chapter shall submit to the ,secretary a claim for payment for furnishing the care or services not later than #ahj days after the date on which the entity or provider furnished the care or services4 7c7 ,fraudulent claims 7#a7 ,sections #cgbi through #cgcc of title #ca shall apply to fraudulent claims for payment submitted to the ,secretary by a health care entity or provider under this chapter4 7#b7 ,pursuant to regulations prescribed by the ,secretary1 the ,secretary shall bar a health care entity or provider from furnishing hospital care1 medical services1 and extended care services under this chapter when the ,secretary determines the entity or provider has submitted to the ,secretary fraudulent health care claims for payment by the ,secretary4 7d7 ,overdue claims 7#a7 ,any claim that has not been denied with notice1 made pending with notice1 or paid to the health care entity or provider by the ,secretary shall be overdue if the notice or payment is not received by the entity or provider within the time periods specified in subsection 7a74 7#b7 7,a7 ,if a claim is overdue under this subsection1 the ,secretary may1 under the requirements established by subsection 7a7 and consistent with the provisions of chapter #ci of title #ca 7commonly referred to as the ,prompt ,payment ,act71 require that interest be paid on clean claims4 7,b7 ,interest paid under subparagraph 7,a7 shall be computed at the rate of interest established by the ,secretary of the ,treasury under section #cijb of title #ca and published in the ,federal ,register4 7e7 ,overpayment 7#a7 ,the ,secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this chapter4 7#b7 ,deductions may not be made under this subsection unless the ,secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness4 7#c7 ,the ,secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the ,secretary's ability to recover the full amount of such indebtedness4 7f7 ,information and documentation required 7#a7 ,the ,secretary shall provide to all health care entities and providers participating in a program to furnish hospital care1 medical services1 or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section4 7#b7 ,the ,secretary shall consult with entities in the health care industry1 in the public and private sector1 to determine the information and documentation to include in the list under paragraph 7#a74 7#c7 ,if the ,secretary modifies the information and documentation included in the list under paragraph 7#a71 the ,secretary shall notify all health care entities and providers described in paragraph 7#a7 not later than #cj days before such modifications take effect4 7g7 ,processing of claims ,in processing a claim for compensation for hospital care1 medical services1 or extended care services furnished by a health care entity or provider under this chapter1 the ,secretary shall act through-- 7#a7 a non-,department entity that is under contract or agreement for the program established under section #agjc7;a7 of this title2 or 7#b7 a non-,department entity that specializes in such processing for other ,federal agency health care systems4 7h7 ,report on encounter data system 7#a7 ,not later than #ij days after the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag1 the ,secretary shall submit to the appropriate committees of ,congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other ,federal agencies to allow a contracted entity to act as a fiscal intermediary for the ,federal ,government to distribute1 or pass through1 ,federal ,government funds for certain non-underwritten hospital care1 medical services1 or extended care services4 7#b7 ,the ,secretary may coordinate with the ,department of ,defense1 the ,department of ,health and ,human ,services1 and the ,department of the ,treasury in developing the report required by paragraph 7#a74 7i7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the term clean electronic claim means the transmission of data for purposes of payment of covered health care expenses that is submitted to the ,secretary which contains substantially all of the required data elements necessary for accurate adjudication1 without obtaining additional information from the entity or provider that furnished the care or service1 submitted in such format as prescribed by the ,secretary in regulations for the purpose of paying claims for care or services4 7#c7 ,the term clean paper claim means a paper claim for payment of covered health care expenses that is submitted to the ,secretary which contains substantially all of the required data elements necessary for accurate adjudication1 without obtaining additional information from the entity or provider that furnished the care or service1 submitted in such format as prescribed by the ,secretary in regulations for the purpose of paying claims for care or services4 7#d7 ,the term fraudulent claims means the intentional and deliberate misrepresentation of a material fact or facts by a health care entity or provider made to induce the ,secretary to pay a claim that was not legally payable to that provider4 ,this term1 as used in this section1 shall not include a good faith interpretation by a health care entity or provider of utilization1 medical necessity1 coding1 and billing requirements of the ,secretary4 7#e7 ,the term health care entity or provider includes any non-,department health care entity or provider1 but does not include any ,federal health care entity or provider4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item related to section #agjc;,c1 as added by section #ajc of this ,act1 the following new item3 #agjc;,d4 ,prompt payment standard4 4 #abb4 ,payment rates for community care 7a7 ,in general ,subchapter ,i of chapter #ag1 as amended by section #aba of this ,act1 is further amended by inserting after section #agjc;,d the following new section3 #agjc;,e4 ,payment rates for community care 7a7 ,in general ,except as provided in subsection 7b71 and to the extent practicable1 the rate paid for hospital care or medical services under any provision in this title may not exceed the rate paid by the ,united ,states to a provider of services 7as defined in section #ahfa7u7 of the ,social ,security ,act 7#aciex7u777 or a supplier 7as defined in section #ahfa 7d7 of such ,act 7#db ,u4,s4,c4 #aciex7d777 under the ,medicare program under title ,,xi or title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq4 and #acie et seq47 for the same care or services1 including rates adjusted for critical access hospitals under section #ahcd7;g7 of such ,act 7#db ,u4,s4,c4 #aciem7g774 7b7 ,exception 7#a7 7,a7 ,a higher rate than the rate paid by the ,united ,states as described in subsection 7a7 may be negotiated with respect to the furnishing of care or services to a veteran described in section #agjc7;b7 of this title who resides in a highly rural area or in a market area where the availability of care or services is limited and a higher rate of pay may be required4 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#b7 ,with respect to furnishing care or services under this section in ,alaska1 the ,alaska ,fee ,schedule of the ,department of ,veterans ,affairs shall be followed1 except for when another payment agreement1 including a contract1 provider agreement or ,veterans ,care ,agreement1 is in place4 7#c7 ,with respect to furnishing care or services under this section 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 or after ,january #a1 #bjad1 the ,medicare payment rates under subparagraph 7,a7 shall be calculated based on the payment rates under such agreement4 7c7 ,value-,based reimbursement ,notwithstanding subsection 7a71 the ,secretary shall incorporate1 to the greatest extent practicable1 the use of value-based reimbursement models to promote the provision of high quality care4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #agjc;,d1 as added by section #aba of this ,act1 the following new item3 #agjc;,e4 ,payment ,rates for ,community ,care4 4 #abc4 ,authority to pay for authorized care not subject to an agreement 7a7 ,in general ,subchapter ,,iv of chapter #ha is amended by adding at the end the following new section3 #haei4 ,authority to pay for services authorized but not subject to an agreement 7a7 ,in general ,if1 in the course of furnishing hospital care1 a medical service1 or an extended care service authorized by the ,secretary and pursuant to a contract1 agreement1 or other arrangement with the ,secretary1 a provider that is not a party to the contract1 agreement1 or other arrangement furnishes hospital care1 a medical service1 or an extended care service that the ,secretary considers necessary1 the ,secretary may compensate the provider for the cost of such care or service4 7b7 ,reports on use of authority ,whenever the ,secretary compensates a provider under subsection 7a7 for the furnishing of hospital care1 a medical service1 or an extended care service1 the care coordination team that coordinated the furnishing of such care or service under section #agjc7;e77#a7 of this title shall-- 7#a7 submit to the appropriate committees of ,congress a report on the furnishing of such care2 and 7#b7 analyze the future demand for such care or service from such provider4 7c7 ,new contracts and agreements ,the ,secretary shall take reasonable efforts to enter into a contract1 agreement1 or other arrangement with a provider described in subsection 7a7 to ensure that future care and services authorized by the ,secretary and furnished by the provider are subject to such a contract1 agreement1 or other arrangement4 7d7 ,definitions ,in this section3 7#a7 ,the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 7#b7 ,the terms hospital care and medical service have the meanings given such terms in section #agja of this title4 4 7b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #haeh the following new item3 #haei4 ,authority to pay for services authorized but not subject to an agreement4 4 ,,ii ,streamlining community care programs ,a ,streamlining community care programs #bja4 ,access to walk-in care 7a7 ,in general ,chapter #ag is amended by inserting after section #agbe the following new section3 #agbe;,a4 ,access to walk-in care 7a7 ,procedures ,to ensure access to walk-,in care ,the ,secretary shall develop procedures to ensure that covered veterans are able to access walk-in care from qualifying non-,department entities or providers4 7b7 ,covered veterans ,for purposes of this section1 a covered veteran is any veteran described in section #agjc7;b7 of this title4 7c7 ,qualifying non-,department entities or providers ,for purposes of this section1 a qualifying non-,department entity or provider is a non-,department entity or provider that-- 7#a7 has entered into a contract or other agreement with the ,secretary to furnish services under this section2 or 7#b7 entered into an agreement with the ,secretary that was in effect on the day before the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag to furnish walk-in care4 7d7 ,federally-,qualified health centers ,whenever practicable1 the ,secretary may use a ,federally-qualified health center 7as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b777 to carry out this section4 7e7 ,continuity of care 7#a7 ,the ,secretary shall ensure continuity of care for each covered veteran who receives a walk-in care service under this section through the care coordination team provided such covered veteran under section #agjc7;e77#a7 of this title4 7#b7 ,the ,secretary shall inform and educate covered veterans on procedures to utilize and access walk-in care under this section4 7#c7 ,the ,secretary shall develop a mechanism to coordinate with qualifying non-,department entities or providers through the care coordination teams provided under section #agjc7;e77#a7 of this title that includes the use of medical records from walk-in care providers to accurately represent access to care1 health needs of the covered veterans1 and to monitor conditions of covered veterans4 7f7 ,copayments 7#a7 ,the ,secretary shall require each covered veteran to pay the ,united ,states a copayment for each episode of walk-in care provided under this section1 except if the episode of walk-in care for the covered veteran is related to a service-connected disability of the covered veteran4 7#b7 ,the ,secretary may adjust the copayment required of a covered veteran under this subsection based upon the priority group of enrollment of the veteran1 the number of episodes of care furnished to a covered veteran during a year1 and other factors the ,secretary considers appropriate under this section4 7#c7 ,the amount or amounts of the copayments required under this subsection shall be prescribed by the ,secretary by rule4 7#d7 ,copayments required by this subsection shall apply notwithstanding any other provision of law that would allow the ,secretary to offset a covered veteran's copayment obligation with amounts recovered from a third party under section #agbi of this title4 7g7 ,regulations ,not later than one year after the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag1 the ,secretary shall promulgate regulations to carry out this section4 7h7 ,walk-,in care defined ,in this section1 the term walk-in care means non-urgent1 non-emergent1 convenience care provided by a qualifying non-,department entity or provider that furnishes episodic care and not longitudinal management of conditions and certain services as defined through contracts or agreements described in subsection 7c7 or regulations the ,secretary shall prescribe for purposes of this section4 4 7b7 ,effective date ,section #agbe;,a of title #ch1 ,united ,states ,code1 as added by subsection 7a7 shall take effect on the date upon which final regulations implementing such section take effect4 7c7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item related to section #agbe the following new item3 #agbe;,a4 ,access to walk-in care4 4 #bjb4 ,veterans ,choice ,fund flexibility ,section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended-- 7#a7 in subsection 7c7-- 7,a7 in paragraph 7#a71 by striking by paragraph 7#c7 and inserting in paragraphs 7#c7 and 7#d72 and 7,b7 by adding at the end the following new paragraph3 7#d7 ,permanent authority for other uses ,beginning in fiscal year #bjai1 amounts remaining in the ,veterans ,choice ,fund may be used to furnish hospital care1 medical services1 and extended care services to individuals pursuant to chapter #ag of title #ch1 ,united ,states ,code1 at non-,department facilities or through non-,department providers at ,department facilities1 including pursuant to non-,department provider programs other than the program established by section #aja4 ,such amounts shall be available in addition to amounts available in other appropriations accounts for such purposes4 2 and 7#b7 in subsection 7d77#a71 by striking to subsection 7c77#c7 and inserting to paragraphs 7#c7 and 7#d7 of subsection 7c74 #bjc4 ,conforming amendments 7a7 ,in general 7#a7 ,title #ch ,title #ch1 ,united ,states ,code1 is amended-- 7,a7 in section #agab7;a7-- 7i7 in paragraph 7#c71 by striking under clause 7#a71 7#b71 or 7#e7 of section #agjc7;a7 of this title and inserting or entered an agreement2 and 7ii7 in paragraph 7#d77;,a71 by striking under the provisions of this subsection and section #agjc of this title2 7,b7 in section #agab;,a7e77#a7-- 7i7 by inserting or agreements after contracts2 and 7ii7 by striking 7under sections #agjc7;a77#b7 and #agaj7;a77#a77;,b7 of this title72 and 7,c7 in section #bcjc7;a77#b77;,b77i71 by striking with section #agjc and inserting with sections #agjc;,a1 #haaa1 and #haec4 7#b7 ,social ,security ,act ,section #ahff7;a77#a77,l7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77,l77 is amended by striking under section #agjc and inserting under chapter #ag4 7#c7 ,veterans' ,benefits ,improvements ,act of #aiid ,section #ajd7;a77#d77;,a7 of the ,veterans' ,benefits ,improvements ,act of #aiid 7,public ,law #ajc-ddf2 #ch ,u4,s4,c4 #aaag note7 is amended by striking in section #agjc and inserting in sections #agjc;,a1 #haaa1 and #haec4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect on the date described in section #aja7;b77#b74 ,b ,improving information sharing with providers #baa4 ,improving information sharing with community providers ,section #gccb7;b77#b7 is amended by striking subparagraph 7,h7 and inserting the following new subparagraphs3 7,h7 7i7 ,to a non-,department entity 7including private entities and other ,federal agencies7 for purposes of providing health care1 including hospital care1 medical services1 and extended care services1 to patients4 7ii7 ,an entity to which a record is disclosed under this subparagraph may not disclose or use such record for a purpose other than that for which the disclosure was made4 7,i7 ,to a third party in order to recover or collect reasonable charges for care furnished to1 or paid on behalf of1 a patient in connection with a non-service connected disability as permitted by section #agbi of this title or for a condition for which recovery is authorized or with respect to which the ,united ,states is deemed to be a third party beneficiary under the ,act entitled ,an ,act to provide for the recovery from tortiously liable third persons of the cost of hospital and medical care and treatment furnished by the ,united ,states 7,public ,law #hg-fic2 #db ,u4,s4,c4 #bfea et seq42 commonly known as the ,federal ,medical ,care ,recovery ,act74 4 #bab4 ,establishment of processes to ensure safe opioid prescribing practices by non-,department of ,veterans ,affairs health care providers 7a7 ,receipt and review of guidelines ,the ,secretary of ,veterans ,affairs shall ensure that all covered health care providers are provided a copy of and certify that they have reviewed the evidence-based guidelines for prescribing opioids set forth by the ,opioid ,safety ,initiative of the ,department of ,veterans ,affairs under sections #iaa7;a77#b7 and #iab7;c7 of the ,jason ,simcakoski ,memorial and ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note7 before first providing care under the laws administered by the ,secretary and at any time when those guidelines are modified thereafter4 7b7 ,inclusion of medical history and current medications ,the ,secretary shall implement a process to ensure that1 if care of a veteran by a covered health care provider is authorized under the laws administered by the ,secretary1 the document authorizing such care includes the relevant medical history of the veteran and a list of all medications prescribed to the veteran4 7c7 ,submittal of prescriptions 7#a7 ,in general ,except as provided in paragraph 7#c71 the ,secretary shall require1 to the maximum extent practicable1 each covered health care provider to submit prescriptions for opioids-- 7,a7 to the ,department for prior authorization for the prescribing of a limited amount of opioids under contracts the ,department has with retail pharmacies2 or 7,b7 directly to a pharmacy of the ,department for the dispensing of such prescription4 7#b7 ,department responsibility ,in carrying out paragraph 7#a71 upon receipt by the ,department of a prescription for opioids for a veteran under the laws administered by the ,secretary1 the ,secretary shall-- 7,a7 record such prescription in the electronic health record of the veteran2 and 7,b7 monitor such prescription as outlined in the ,opioid ,safety ,initiative of the ,department4 7#c7 ,exception 7,a7 ,in general ,a covered health care provider is not required under paragraph 7#a77;,b7 to submit an opioid prescription directly to a pharmacy of the ,department if-- 7i7 the health care provider determines that there is an immediate medical need for the prescription1 including an urgent or emergent prescription or a prescription dispensed as part of an opioid treatment program that provides office-based medications2 and 7ii7 7,i7 following an inquiry into the matter1 a pharmacy of the ,department notifies the health care provider that it cannot fill the prescription in a timely manner2 or 7,,ii7 the health care provider determines that the requirement under paragraph 7#a77;,b7 would impose an undue hardship on the veteran1 including with respect to travel distances1 as determined by the ,secretary4 7,b7 ,notification to ,department ,if a covered health care provider uses an exception under subparagraph 7,a7 with respect to an opioid prescription for a veteran1 the health care provider shall1 on the same day the prescription is written1 submit to the ,secretary for inclusion in the electronic health record of the veteran a notice1 in such form as the ,secretary may establish1 providing information about the prescription and describing the reason for the exception4 7,c7 ,report 7i7 ,in general ,not less frequently than quarterly1 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 evaluating the compliance of covered health care providers with the requirements under this paragraph and setting forth data on the use by health care providers of exceptions under subparagraph 7,a7 and notices under subparagraph 7,b74 7ii7 ,elements ,each report required by clause 7i7 shall include the following with respect to the quarter covered by the report3 7,i7 ,the number of exceptions used under subparagraph 7,a7 and notices received under subparagraph 7,b74 7,,ii7 ,the rate of compliance by the ,department with the requirement under subparagraph 7,b7 to include such notices in the health records of veterans4 7,,iii7 ,the identification of any covered health care providers that1 based on criteria prescribed the ,secretary1 are determined by the ,secretary to be statistical outliers regarding the use of exceptions under subparagraph 7,a74 7d7 ,use of ,opioid ,safety ,initiative guidelines 7#a7 ,in general ,if a director of a medical center of the ,department or a ,veterans ,integrated ,service ,network determines that the opioid prescribing practices of a covered health care provider conflicts with or is otherwise inconsistent with the standards of appropriate and safe care1 as that term is used in section #iac7;d7 of the ,jason ,simcakoski ,memorial and ,promise ,act 7,public ,law #aad-aih2 #ch ,u4,s4,c4 #agja note71 the director shall take such action as the director considers appropriate to ensure the safety of all veterans receiving care from that health care provider1 including removing or directing the removal of any such health care provider from provider networks or otherwise refusing to authorize care of veterans by such health care provider in any program authorized under the laws administered by the ,secretary4 7#b7 ,inclusion in contracts ,the ,secretary shall ensure that any contracts entered into by the ,secretary with third parties involved in administering programs that provide care in the community to veterans under the laws administered by the ,secretary specifically grant the authority set forth in paragraph 7#a7 to such third parties and to the directors described in that paragraph1 as the case may be4 7e7 ,denial or revocation of eligibility of non-,department providers ,the ,secretary shall deny or revoke the eligibility of a non-,department health care provider to provide health care to veterans under the laws administered by the ,secretary if the ,secretary determines that the opioid prescribing practices of the provider-- 7#a7 violate the requirements of a medical license of the health care provider2 or 7#b7 detract from the ability of the health care provider to deliver safe and appropriate health care4 7f7 ,covered health care provider defined ,in this section1 the term covered health care provider means a non-,department of ,veterans ,affairs health care provider who provides health care to veterans under the laws administered by the ,secretary of ,veterans ,affairs4 ,c ,improving collections #bba4 ,aligning with best practices on collection of health insurance information ,section #agje;,a is amended-- 7#a7 in subsection 7a77#a71 by striking ,any individual and all that follows through covered4 and inserting the following3 ,any individual who applies for or seeks hospital care or medical services under this chapter shall1 at the time of such application1 or otherwise when requested by the ,secretary1 furnish the ,secretary with such current information as the ,secretary may require to identify any health-plan contract1 as defined in subsection 7i77l7 of section #agbi1 under which such individual is covered1 to include1 as applicable1 the name1 address1 and telephone number of such health-plan contract2 the name of the policy holder1 if coverage under a health-plan contract is in the name of a person other than such individual2 the plan identification number2 and the group code of the plans42 and 7#b7 in subsection 7c7-- 7,a7 by striking ,the ,secretary and inserting 7#a7 ,except as provided in paragraph 7#b71 the ,secretary2 and 7,b7 by adding at the end the following new paragraph3 7#b7 ,the ,secretary may charge an individual who does not provide the information required by subsection 7a7 reasonable charges for the provision of such care and services4 4 #bbb4 ,improving authority to collect 7a7 ,broadening scope of applicability ,section #agbi is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#b77;,a7-- 7i7 by striking the veteran's and inserting the individual's2 and 7ii7 by striking the veteran and inserting the individual2 and 7,b7 in paragraph 7#c7-- 7i7 in the matter preceding subparagraph 7,a71 by striking the veteran and inserting the individual2 and 7ii7 in subparagraph 7,a71 by striking the veteran's and inserting the individual's2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#a7-- 7i7 by striking the veteran and inserting the individual2 and 7ii7 by striking the veteran's and inserting the individual's2 and 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,a7-- 7,i7 by striking the veteran and inserting the individual2 and 7,,ii7 by striking the veteran's and inserting the individual's2 and 7ii7 in subparagraph 7,b7-- 7,i7 in clause 7i71 by striking the veteran and inserting the individual2 and 7,,ii7 in clause 7ii7-- 7aa7 by striking the veteran and inserting the individual2 and 7bb7 by striking the veteran's each place it appears and inserting the individual's2 7#c7 in subsection 7e71 by striking ,a veteran and inserting ,an individual2 and 7#d7 in subsection 7h7-- 7,a7 in paragraph 7#a7-- 7i7 in the matter preceding subparagraph 7,a71 by striking a veteran and inserting an individual2 7ii7 in subparagraph 7,a71 by striking the veteran and inserting the individual2 and 7iii7 in subparagraph 7,b71 by striking the veteran and inserting the individual2 and 7,b7 in paragraph 7#b7-- 7i7 by striking ,a veteran and inserting ,an individual2 7ii7 by striking a veteran and inserting an individual2 and 7iii7 by striking the veteran and inserting the individual4 7b7 ,additional amendments ,such section is further amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a71 by striking 7#a7 ,subject and all that follows through the period and inserting the following3 7#a7 ,subject to the provisions of this section1 in any case in which the ,united ,states is required by law to furnish or pay for care or services under this chapter for a non-service-connected disability described in paragraph 7#b7 of this subsection1 the ,united ,states has the right to recover or collect from a third party the reasonable charges of care or services so furnished or paid for to the extent that the recipient or provider of the care or services would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished or paid for by a department or agency of the ,united ,states42 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,c71 by striking the semicolon and inserting 2 or2 7ii7 by amending subparagraph 7,d7 to read as follows3 7,d7 that is incurred by an individual who is entitled to care 7or payment of the expenses of care7 under a health-plan contract4 2 and 7iii7 by striking subparagraph 7,e72 and 7,c7 by adding at the end the following new paragraph3 7#d7 ,in the case of a health-plan contract where the ,united ,states has a right to recover or collect reasonable charges1 the ,secretary shall collect from a veteran or responsible individual any copayment or cost-share required under this chapter4 2 7#b7 in subsection 7b71 by adding at the end the following new paragraph3 7#c7 7,a7 ,the obligation of the third party to pay is not dependent upon an individual executing an assignment of benefits to the ,united ,states1 nor is the obligation to pay dependent upon any other submission by the beneficiary to the third party1 including any claim or appeal4 7,b7 ,in any case in which the ,secretary makes a claim1 appeal1 representation1 or other filing under the authority of this chapter1 any procedural requirement in any third-party plan for the beneficiary of such plan to make the claim1 appeal1 representation1 or other filing is deemed to be satisfied4 2 and 7#c7 in subsection 7f7-- 7,a7 by inserting 7#a7 before ,no law2 and 7,b7 by adding at the end the following new paragraph3 7#b7 ,the absence of a participating provider agreement1 ,veterans ,care ,agreement1 or other contractual arrangement with a third party described in subsection 7i77#c77;,d7 shall not operate to prevent1 or reduce the amount of1 any such recovery or collection by the ,united ,states4 ,for purposes of this section1 the ,department shall recover or collect as if it were a participating provider4 2 and 7c7 ,definitions ,subsection 7i7 of such section is amended to read as follows3 7i7 ,in this section3 7#a7 ,the term health-plan contract includes any of the following3 7,a7 ,an insurance policy or contract including any health maintenance organization1 preferred provider organization1 point of service organization1 accountable care organization1 or any other type of health insurance policy or contract1 medical or hospital service agreement1 membership or subscription contract1 or similar arrangement under which hospital care or medical services for individuals are provided or the expenses of such services are paid4 7,b7 ,a workers' compensation law or plan4 7#b7 ,the term payment includes reimbursement and indemnification4 7#c7 ,the term third party means any of the following3 7,a7 ,a ,state or political subdivision of a ,state4 7,b7 ,an employer or an employer's insurance carrier4 7,c7 ,an automobile accident reparations or liability insurance carrier4 7,d7 ,a person or entity obligated to provide1 or to pay the expenses of1 health services under a health-plan contract4 7#d7 ,the term reasonable charges shall include the following3 7,a7 ,for hospital care or medical services furnished by the ,department1 charges established in accordance with this section4 7,b7 ,for hospital care or medical services paid for under subparagraphs 7,a7 and 7,b7 of subsection 7a77#b71 the amount paid to a non-,department entity or provider4 4 ,,iii ,improving ,department of ,veterans ,affairs care delivery ,a ,improving personnel practices #cja4 ,licensure of health care professionals of the ,department of ,veterans ,affairs providing treatment via telemedicine 7a7 ,in general ,chapter #ag1 as amended by section #ajb1 is further amended by adding at the end the following new section3 #agcj;,c4 ,licensure of health care professionals providing treatment via telemedicine 7a7 ,in general ,notwithstanding any provision of law regarding the licensure of health care professionals1 a covered health care professional may practice the health care profession of the health care professional at any location in any ,state1 regardless of where in a ,state the covered health care professional or the patient is located1 if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter4 7b7 ,covered health care professionals ,for purposes of this section1 a covered health care professional is any health care professional who-- 7#a7 is an employee of the ,department appointed under this title or title #e2 7#b7 is authorized by the ,secretary to provide health care under this chapter2 7#c7 is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the ,department2 and 7#d7 has an active1 current1 full1 and unrestricted license1 registration1 or certification in a ,state to practice the health care profession of the health care professional4 7c7 ,property of ,federal government ,subsection 7a7 shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the ,federal ,government during such treatment4 7d7 ,relation to ,state law 7#a7 ,the provisions of this section shall supersede any provisions of the law of any ,state to the extent that such provision of ,state law are inconsistent with this section4 7#b7 ,no ,state shall deny or revoke the license1 registration1 or certification of a covered health care professional who otherwise meets the qualifications of the ,state for holding the license1 registration1 or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection 7a74 7e7 ,rule of construction ,nothing in this section may be construed to remove1 limit1 or otherwise affect any obligation of a covered health care professional under the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hja et seq474 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #ag of such title is amended by inserting after the item relating to section #agcj;,b1 as added by section #ajb1 the following new item3 #agcj;,c4 ,licensure of health care professionals providing treatment via telemedicine4 4 7c7 ,report on telemedicine 7#a7 ,in general ,not later than one year after the earlier of the date on which services provided under section #agcj;,c of title #ch1 ,united ,states ,code1 as added by subsection 7a71 first occur or regulations are promulgated to carry out such section1 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 effectiveness of the use of telemedicine by the ,department of ,veterans ,affairs4 7#b7 ,elements ,the report required by paragraph 7#a7 shall include an assessment of the following3 7,a7 ,the satisfaction of veterans with telemedicine furnished by the ,department4 7,b7 ,the satisfaction of health care providers in providing telemedicine furnished by the ,department4 7,c7 ,the effect of telemedicine furnished by the ,department on the following3 7i7 ,the ability of veterans to access health care1 whether from the ,department or from non-,department health care providers4 7ii7 ,the frequency of use by veterans of telemedicine4 7iii7 ,the productivity of health care providers4 7iv7 ,wait times for an appointment for the receipt of health care from the ,department4 7v7 ,the use by veterans of in-person services at ,department facilities and non-,department facilities4 7,d7 ,the types of appointments for the receipt of telemedicine furnished by the ,department that were provided during the one-year period preceding the submittal of the report4 7,e7 ,the number of appointments for the receipt of telemedicine furnished by the ,department that were requested during such period1 disaggregated by medical facility4 7,f7 ,savings by the ,department1 if any1 including travel costs1 from furnishing health care through the use of telemedicine during such period4 #cjb4 ,graduate medical education and residency 7a7 ,increase in number of graduate medical education residency positions 7#a7 ,in general ,the ,secretary of ,veterans ,affairs shall increase the number of graduate medical education residency positions at covered facilities by not fewer than #a1ejj positions in the #aj-year period beginning on the date of the enactment of this ,act4 7#b7 ,covered facilities ,for purposes of this section1 a covered facility is any of the following3 7,a7 ,a facility of the ,department of ,veterans ,affairs4 7,b7 ,a facility operated by an ,indian tribe or a tribal organization1 as those terms are defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #ecjd74 7,c7 ,a facility operated by the ,indian ,health ,service4 7,d7 ,a ,federally-qualified health center1 as defined in section #aije7l77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7l77#b77;,b774 7,e7 ,a community health center4 7,f7 ,a facility operated by the ,department of ,defense4 7,g7 ,such other health care facility as the ,secretary considers appropriate for purposes of this section4 7#c7 ,stipends and benefits ,the ,secretary may pay stipends and provide benefits for residents in positions under paragraph 7#a71 regardless of whether they have been assigned in a ,department facility4 7#d7 ,parameters for location1 affiliate sponsor1 and duration ,when determining characteristics of residency positions under paragraph 7#a71 the ,secretary shall consider the extent to which there is a clinical need for providers1 as determined by the market area assessment most recently performed under section #agcj;,b7c7 of title #ch1 ,united ,states ,code1 as added by section #ajb4 7#e7 ,parameters for types of specialties ,when determining the types of specialties to be included in residency positions under paragraph 7#a71 the ,secretary shall consider the following3 7,a7 ,the types of specialties that improve the quality and coverage of medical services provided to veterans4 7,b7 ,the range of clinical specialties covered by providers in standardized geographic areas surrounding facilities4 7,c7 ,whether the specialty is included in the most recent staffing shortage determination of the ,department under section #gdab of title #ch1 ,united ,states ,code4 7,d7 ,the most recent market area assessment performed under section #agcj;,b7c7 of title #ch1 ,united ,states ,code1 as added by section #ajb4 7b7 ,application ,to participate ,to participate as a resident in one of the positions increased under subsection 7a77#a71 an individual shall submit to the ,secretary an application therefor together with an agreement described in subsection 7d7 under which the participant agrees to serve a period of obligated service in the ,veterans ,health ,administration as provided in the agreement in return for payment of stipend and benefit support as provided in the agreement4 7c7 ,selection 7#a7 ,in general ,an individual becomes a participant in a residency program under this section upon the ,secretary's approval of the individual's application under subsection 7b7 and the ,secretary's acceptance of the agreement under subsection 7d7 7if required74 7#b7 ,notice ,upon the ,secretary's approval of an individual's participation in the program under paragraph 7#a71 the ,secretary shall promptly notify the individual of that approval4 ,such notice shall be in writing4 7d7 ,agreement 7#a7 ,in general ,an agreement between the ,secretary and a resident in a position under subsection 7a77#a7 shall be in writing and shall be signed by the resident containing such terms as the ,secretary may specify4 7#b7 ,requirements ,the agreement must specify the terms of the service obligation resulting from participating as a resident under this section1 including by requiring a service obligation equal to the number of years of stipend and benefit support4 7e7 ,conditions of employment ,the ,secretary may prescribe the conditions of employment of persons appointed to positions under subsection 7a77#a71 including necessary training1 and the customary amount and terms of pay for such positions during the period of such employment and training4 7f7 ,obligated service 7#a7 ,in general ,each person appointed to a position under subsection 7a77#a7 shall provide service as a full-time employee of the ,department for the period of obligated service provided in the agreement of the participant entered into under subsection 7d74 ,such service shall be provided in the full-time clinical practice of such participant's profession or in another health-care position in an assignment or location determined by the ,secretary4 7#b7 ,commencement date ,not later than #fj days before the date on which a person commences serving in a position under subsection 7a77#a71 the ,secretary shall notify the person of such date4 ,such date shall be the first day of the person's period of obligated service4 7g7 ,breach of agreement3 liability 7#a7 ,penalty ,a person appointed under this section to a position under subsection 7a77#a7 7other than a person who is liable under paragraph 7#b77 who fails to accept payment1 or instructs the educational institution in which the person is enrolled not to accept payment1 in whole or in part1 for a residency under the agreement entered into under subsection 7d7 of this title shall be liable to the ,united ,states for liquidated damages in the amount of #a1ejj4 ,such liability is in addition to any period of obligated service or other obligation or liability under the agreement4 7#b7 ,liability 7,a7 ,in general ,a person appointed to a position under subsection 7a77#a7 shall be liable to the ,united ,states for the amount which has been paid to or on behalf of the person under the agreement if any of the following occurs3 7i7 ,the person is dismissed from the position for disciplinary reasons4 7ii7 ,the person voluntarily terminates the residency before the completion of such course of training4 7iii7 ,the person loses the person's license1 registration1 or certification to practice the person's health care profession in a ,state4 7,b7 ,liability supplants service obligation ,liability under this paragraph is in lieu of any service obligation arising under the person's agreement under subsection 7d74 7h7 ,recovery 7#a7 ,in general ,if a person breaches the person's agreement under subsection 7d7 by failing 7for any reason7 to complete such person's period of obligated service1 the ,united ,states shall be entitled to recover from the person an amount equal to the product of-- 7,a7 three2 7,b7 the sum of-- 7i7 the amounts paid under this section to or on behalf of the person2 and 7ii7 the interest on such amounts that would be payable if at the time the amounts were paid they were loans bearing interest at the maximum legal prevailing rate1 as determined by the ,treasurer of the ,united ,states2 and 7,c7 the quotient of-- 7i7 the difference between-- 7,i7 the total number of months in the person's period of obligated service2 and 7,,ii7 the number of months of such period served by the person2 and 7ii7 the total number of months in the person's period of obligated service4 7#b7 ,period of recovery ,any amount which the ,united ,states is entitled to recover under this subsection shall be paid to the ,united ,states not later than the date that is one year after the date of the breach of the agreement4 7i7 ,annual report 7#a7 ,in general ,not later than one year after the date of the enactment of this ,act and not less frequently than once each year thereafter1 the ,secretary shall submit to the appropriate committees of ,congress a report on the implementation of this section during the previous year4 7#b7 ,contents ,each report submitted under paragraph 7#a7 shall include1 for the period covered by the report1 the following3 7,a7 ,the number of positions described in subsection 7a7 that were filled4 7,b7 ,the location of each such position4 7,c7 ,the academic affiliate associated with each such position4 7,d7 ,a description of the challenges faced in filling the positions described in subsection 7a7 and the actions the ,secretary has taken to address such challenges4 7#c7 ,appropriate committees of ,congress defined ,in this subsection1 the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 #cjc4 ,annual report on awards or bonuses awarded to certain high-level employees of the department of veterans affairs 7a7 ,in general ,chapter #g is amended by adding at the end the following new section3 #gbf4 ,annual report on awards to certain high-level employees 7a7 ,in general ,not later than #cj days after the end of each fiscal year1 the ,secretary shall submit to the appropriate committees of ,congress a report that contains1 for the most recent fiscal year ending before the submittal of the report1 a description of the performance awards and bonuses awarded to ,regional ,office ,directors of the ,department1 ,directors of ,medical ,centers of the ,department1 and ,directors of ,veterans ,integrated ,service ,networks4 7b7 ,elements ,each report submitted under subsection 7a7 shall include the following with respect to each award or bonus awarded to an individual described in such subsection3 7#a7 ,the type of award or bonus1 specifically those awarded for performance or on the basis of recruitment1 relocation and retention as the case may be4 7#b7 ,the amount of each award or bonus4 7#c7 ,the job title of the individual awarded the award or bonus4 7#d7 ,the location where the individual awarded the award or bonus works4 7c7 ,appropriate committees of congress ,in this section1 the term appropriate committees of ,congress means-- 7#a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7#b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 4 7b7 ,clerical amendment ,the table of sections at the beginning of chapter #g of such title is amended by inserting after the item relating to section #gbe the following new item3 #gbf4 ,annual report on awards to certain high-level employees4 4 ,b ,facilities1 construction1 and leases #caa4 ,facilitating sharing of medical facilities with other ,federal agencies 7a7 ,construction or lease of shared facility 7#a7 ,in general ,subchapter ,i of chapter #ha is amended by inserting after section #haaa;,a the following new section3 #haaa;,b4 ,authority to plan1 design1 construct1 or lease a shared medical facility 7a7 ,in general 7#a7 ,the ,secretary may enter into agreements with other ,federal agencies for the planning1 designing1 constructing1 or leasing shared medical facilities with the goal of improving access to1 and quality and cost effectiveness of1 health care provided by the ,department and other ,federal agencies4 7#b7 ,facilities planned1 designed1 constructed1 or leased under paragraph 7#a7 shall be managed by the ,director of the ,high-,performing ,integrated ,healthcare ,network of the ,department designated under section #agcj;,b7a7 of this title4 7b7 ,transfer of amounts to other ,federal agencies 7#a7 ,the ,secretary may transfer to another ,federal agency amounts appropriated to the ,department for ,construction1 ,minor ,projects for use for the planning1 design1 or construction of a shared medical facility if the estimated share of the project costs to be borne by the ,department does not exceed the threshold for a major medical facility construction project under section #hajd7;a77#c77;,a7 of this title4 7#b7 ,the ,secretary may transfer to another ,federal agency amounts appropriated to the ,department for ,construction1 ,major ,projects for use for the planning1 design1 or construction of a shared medical facility if-- 7,a7 the estimated share of the project costs to be borne by the ,department is more than the threshold for a major medical facility construction project under subsection 7a77#c77;,a7 of section #hajd of this title2 and 7,b7 the requirements for such a project under such section have been met4 7#c7 ,the ,secretary may transfer to another ,federal agency amounts appropriated to the applicable appropriations account of the ,department for the purpose of leasing space for a shared medical facility if the estimated share of the lease costs to be borne by the ,department does not exceed the threshold for a major medical facility lease under section #hajd7;a77#c77;,b7 of this title4 7c7 ,transfer of amounts to ,department 7#a7 ,amounts transferred to the ,department by another ,federal agency for the necessary expenses of planning1 designing1 or constructing a shared medical facility for which the estimated share of the project costs to be borne by the ,department does not exceed the threshold for a major medical facility project under section #hajd7;a77#c77;,a7 of this title may be deposited in the ,construction1 ,minor ,projects account of the ,department and used for such necessary expenses4 7#b7 ,amounts transferred to the ,department by another ,federal agency for the necessary expenses of planning1 designing1 or constructing a shared medical facility for which the estimated share of the project costs to be borne by the ,department is more than the threshold for a major medical facility project under section #hajd7;a77#c77;,a7 of this title may be deposited in the ,construction1 ,major ,projects account of the ,department and used for such necessary expenses if the requirements for such project under section #hajd of this title have been met4 7#c7 ,amounts transferred to the ,department by another ,federal agency for the purpose of leasing space for a shared medical facility may be credited to the applicable appropriations account of the ,department and shall be available without fiscal year limitation4 7#d7 ,amounts transferred under paragraphs 7#a7 and 7#b7 shall be available for the same time period as amounts in the account to which those amounts are transferred4 4 7#b7 ,clerical amendment ,the table of sections at the beginning of such chapter is amended by inserting after the item relating to section #haaa;,a the following new item3 #haaa;,b4 ,authority to plan1 design1 construct1 or lease a shared medical facility4 7b7 ,modification of definition of medical facility ,paragraph 7#c7 of section #haja is amended to read as follows3 7#c7 ,the term medical facility means any facility or part thereof that is1 or will be1 under the jurisdiction of the ,secretary1 or as otherwise designated by law1 for the provision of healthcare services 7including hospital care1 outpatient care1 nursing home care1 domiciliary care1 or medical services71 including any necessary building and auxiliary structure1 garage1 parking facility1 mechanical equipment1 trackage facilities leading thereto1 abutting sidewalks1 accommodations for attending personnel1 and recreation facilities associated therewith4 4 #cab4 ,review of enhanced use leases ,section #hafb is amended-- 7#a7 in subsection 7a71 by amending paragraph 7#b7 to read as follows3 7#b7 ,with respect to enhanced-use leases entered into on or after the date of enactment of the ,veterans ,community ,care and ,access ,act of #bjag1 the ,secretary may enter into an enhanced-use lease only if the ,secretary determines that-- 7,a7 the lease will not be inconsistent with and will not adversely affect the mission of the ,department2 and 7,b7 7i7 the lease will enhance the use of the property2 or 7ii7 the leased property will provide supportive housing as defined in section #hafa of this title4 2 and 7#b7 in subsection 7b71 by amending paragraph 7#f7 to read as follows3 7#f7 ,the ,director of the ,office of ,management and ,budget shall review each such enhanced-use lease prior to execution for compliance with paragraph 7#e7 of this subsection4 4 ,,iv ,innovative pilot programs #dja4 ,pilot program to establish or affiliate with graduate medical residency programs at facilities operated by ,indian tribes1 tribal organizations1 and the ,indian ,health ,service in rural areas 7a7 ,pilot program required ,the ,secretary of ,veterans ,affairs1 in consultation with the ,director of the ,indian ,health ,service1 shall carry out a pilot program-- 7#a7 to establish graduate medical education residency training programs at covered facilities2 or 7#b7 to affiliate with established programs described in paragraph 7#a74 7b7 ,covered facilities ,for purposes of the pilot program1 a covered facility is any facility-- 7#a7 described in subparagraph 7,b7 or 7,c7 of section #cjb7;a77#b72 and 7#b7 located in a rural or remote area1 as determined by the ,secretary and the ,director of the ,indian ,health ,service4 7c7 ,locations 7#a7 ,in general ,the ,secretary shall carry out the pilot program at not more than five covered facilities that have been selected by the ,secretary for purposes of the pilot program4 7#b7 ,criteria ,the ,secretary shall establish criteria for selecting covered facilities under paragraph 7#a74 7d7 ,duration ,the ,secretary shall carry out the pilot program during the eight-year period beginning on the date that is #ahj days after the date of the enactment of this ,act4 7e7 ,reimbursement of costs ,the ,secretary shall reimburse each covered facility participating in the pilot program for the following costs associated with the pilot program3 7#a7 ,curriculum development4 7#b7 ,recruitment1 training1 supervision1 and retention of residents and faculty4 7#c7 ,accreditation of programs of education under the pilot program by the ,accreditation ,council for ,graduate ,medical ,education 7,,acgme7 or the ,american ,osteopathic ,association 7,,aoa74 7#d7 ,the portion of faculty salaries attributable to activities relating to carrying out the pilot program4 7#e7 ,payment for expenses relating to providing medical education under the pilot program4 7#f7 ,stipends and benefits4 7f7 ,period of obligated service 7#a7 ,in general ,the ,secretary shall enter into an agreement with each individual who participates in the pilot program under which such individual agrees to serve under the same terms as established under section #cjb4 7#b7 ,loan repayment ,during the period of obligated service of an individual under paragraph 7#a71 the individual-- 7,a7 shall be deemed to be an eligible individual under subsection 7b7 of section #ajh of the ,indian ,health ,care ,improvement ,act 7#be ,u4,s4,c4 #afaf;a7 for purposes of participation in the ,indian ,health ,service ,loan ,repayment ,program under such section during the portion of such period that the individual serves at a covered facility2 and 7,b7 shall be deemed to be an eligible individual under section #gfhb7;a7 of title #ch1 ,united ,states ,code1 for purposes of participation in the ,department of ,veterans ,affairs ,education ,debt ,reduction ,program under subchapter ,,vii of chapter #gf of such title during the portion of such period that the individual serves at a facility of the ,department4 7#c7 ,concurrent service ,any period of obligated service required of an individual under paragraph 7#a7 shall be served-- 7,a7 with respect to service at a covered facility1 concurrently with any period of obligated service required of the individual by the ,indian ,health ,service2 and 7,b7 with respect to service at a facility of the ,department of ,veterans ,affairs1 concurrently with any period of obligated service required of the individual by the ,department4 7g7 ,treatment of participants ,a residency position into which a participant in the pilot program is placed as part of the pilot program shall be considered a position referred to in section #cjb7;a77#a7 for purposes of the limitation on number of new positions authorized under such section4 7h7 ,report ,not later than three years before the date on which the pilot program terminates1 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 feasibility and advisability of-- 7#a7 expanding the pilot program to additional locations2 and 7#b7 making the pilot program or any aspect of the pilot program permanent4 #djb4 ,authority for ,department of ,veterans ,affairs ,center for ,innovation for ,care and ,payment 7a7 ,in general ,subchapter ,i of chapter #ag1 as amended by section #abb1 is further amended by inserting after section #agjc;,e1 as added by section #abb1 the following new section3 #agjc;,f4 ,center for ,innovation for ,care and ,payment 7a7 ,in general 7#a7 ,there is established within the ,department a ,center for ,innovation for ,care and ,payment 7in this section referred to as the ,center74 7#b7 ,the ,secretary1 acting through the ,center1 may carry out such pilot programs as appropriate to develop new1 innovative approaches to testing payment and service delivery models to reduce expenditures while preserving or enhancing the quality of care furnished by the ,department4 7#c7 ,the ,secretary1 acting through the ,center1 shall test payment and service delivery models to determine whether such models improve the access to and quality1 timeliness1 and patient satisfaction of such care and services1 as well as the cost savings associated with such models4 7#d7 7,a7 ,the ,secretary shall test models where the ,secretary determines that there is evidence that the model addresses a defined population for which there are deficits care leading to poor clinical outcomes or potentially avoidable expenditures4 7,b7 ,the ,secretary shall focus on models expected to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter4 7,c7 ,the models selected may include those described in section #aaae;,a7b77#b77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acae;a7b77#b77;,b774 7#e7 ,in selecting models for testing1 the ,secretary may consider the following additional factors3 7,a7 ,whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of applicable individuals4 7,b7 ,whether the model places the applicable individual1 including family members and other caregivers of the applicable individual1 at the center of the care team of the applicable individual4 7,c7 ,whether the model uses technology or new systems to coordinate care over time and across settings4 7,d7 ,whether the model demonstrates effective linkage with other public sector payers1 private sector payers1 or statewide payment models4 7#f7 7,a7 ,models tested under this section may not be designed in such a way that would allow the ,united ,states to recover or collect reasonable charges from a ,federal health care program for care or services furnished by the ,secretary to veterans under pilot programs carried out under this section4 7,b7 ,in this paragraph1 the term ,federal health care program means-- 7i7 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;j72 or 7ii7 a ,state plan for medical assistance approved under title ,,xix of such ,act 7#db ,u4,s4,c4 #acif et seq472 or 7iii7 a ,,tricare program operated under sections #ajge1 #ajge;a1 #ajgf1 #ajgf;a1 #ajgf;c1 #ajgf;d1 #ajgf;e1 or #ajgf;f of title #aj4 7b7 ,duration ,pilot programs carried out by the ,secretary under this section shall terminate no later than five years after their commencement4 7c7 ,location ,the ,secretary shall ensure that pilot programs carried out under this section occur in different areas that are appropriate for the intended purposes of the pilot program4 7d7 ,budget ,funding for pilot programs carried out by the ,secretary under this section will be derived from appropriations provided in advance in appropriations ,acts for the ,veterans ,health ,administration and from appropriations provided for information technology systems4 7e7 ,notice ,the ,secretary shall publish information about such pilot programs in the ,federal ,register1 and shall take reasonable actions to provide direct notice to veterans eligible to participate in a pilot program operated under this section4 7f7 ,waiver of authorities 7#a7 ,subject to reporting under paragraph 7#b7 and approval under paragraph 7#c71 in implementing the pilot programs under this section1 the ,secretary may waive such requirements in subchapters ,i1 ,,ii1 and ,,iii of this chapter as may be necessary solely for the purposes of carrying out this section with respect to testing models described in subsection 7a74 7#b7 ,before waiving any authority under paragraph 7#a71 the ,secretary shall submit a report to the ,speaker of the ,house of ,representatives1 the minority leader of the ,house of ,representatives1 the majority leader of the ,senate1 the minority leader of the ,senate1 and each standing committee with jurisdiction under the rules of the ,senate of the ,house of ,representatives to report a bill to amend the provision or provisions of law that would be waived by the ,department describing in detail the following3 7,a7 ,the specific authorities to be waived under the pilot program4 7,b7 ,the standard or standards to be used in the pilot program in lieu of the waived authorities4 7,c7 ,the reasons for such waiver or waivers4 7,d7 ,a description of the metric or metrics the ,secretary will use to determine the effect of the waiver or waivers upon the access to and quality1 timeliness1 or patient satisfaction of care and services furnished through the pilot program4 7,e7 ,the anticipated cost savings1 if any1 of the pilot program4 7,f7 ,the schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program4 7,g7 ,the schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent4 7,h7 ,the estimated budget of the pilot program4 7#c7 7,a7 ,upon receipt of a report submitted under paragraph 7#b71 each ,house shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the ,house of ,representatives or the ,senate to report a bill to amend the provision or provisions of law that would be waived by the ,department under this subsection4 7,b7 7i7 ,the waiver requested by the ,secretary under paragraph 7#b7 shall be considered approved under this paragraph if there is enacted into law a bill or joint resolution approving such request in its entirety4 ,such bill or joint resolution shall be passed by recorded vote to reflect the vote of each member of ,congress thereon4 7ii7 ,the provisions of this paragraph are enacted by the ,congress-- 7,i7 as an exercise of the rulemaking power of the ,senate and the ,house of ,representatives and as such shall be considered as part of the rules of each ,house1 and shall supersede other rules only to the extent that they are inconsistent therewith2 and 7,,ii7 with full recognition of the constitutional right of either ,house to change the rules 7so far as they relate to the procedures of that ,house7 at any time1 in the same manner1 and to the same extent as in the case of any other rule of that ,house4 7,c7 ,during the #fj-;calendar-day period beginning on the date on which the ,secretary submits the report described in paragraph 7#b7 to ,congress1 it shall be in order as a matter of highest privilege in each ,house of ,congress to consider a bill or joint resolution1 if offered by the majority leader of such ,house 7or a designee71 approving such request in its entirety4 7g7 ,limitations 7#a7 ,the waiver provisions in subsection 7f7 shall not be available unless the ,secretary submits the first proposal1 in accordance with the requirements in subsection 7f71 for a pilot program within #ah months of the date of the enactment of the ,veterans ,community ,care and ,access ,act of #bjag4 7#b7 ,notwithstanding section #ejb of this title1 decisions by the ,secretary under this section shall1 consistent with section #eaa of this title1 be final and conclusive and may not be reviewed by any other official or by any court1 whether by an action in the nature of mandamus or otherwise4 7#c7 7,a7 ,if the ,secretary determines that the pilot program is not improving the quality of care or producing cost savings1 the ,secretary shall-- 7i7 propose a modification to the pilot program in the interim report that shall also be considered a report under subsection 7f77#b77;,a7 and shall be subject to the terms and conditions of subsection 7f77#b72 or 7ii7 terminate such pilot program within #cj days of submitting the interim report to ,congress4 7,b7 ,if the ,secretary terminates the pilot program under subparagraph 7,a77ii71 for purposes of clauses 7vi7 and 7vii7 of subsection 7f77#b77;,a71 such interim report will also serve as the final report for that pilot program4 7h7 ,evaluation and reporting requirements 7#a7 ,the ,secretary shall conduct an evaluation of each model tested1 which shall include1 at a minimum1 an analysis of-- 7,a7 the quality of care furnished under the model1 including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the ,secretary2 and 7,b7 the changes in spending by reason of that model4 7#b7 ,the ,secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the ,secretary determines is necessary to monitor and evaluate such models4 7i7 ,coordination and consultation 7#a7 ,the ,secretary shall obtain advice from the ,under ,secretary for ,health and the ,special ,medical ,advisory ,group established pursuant to section #gcab of this title in the development and implementation of any pilot program operated under this section4 7#b7 ,in carrying out the duties under this section1 the ,secretary shall consult representatives of relevant ,federal agencies1 and clinical and analytical experts with expertise in medicine and health care management4 ,the ,secretary shall use appropriate mechanisms to seek input from interested parties4 7j7 ,expansion of successful pilot programs ,taking into account the evaluation under subsection 7f71 the ,secretary may1 through rulemaking1 expand 7including implementation on a nationwide basis7 the duration and the scope of a model that is being tested under subsection 7a7 to the extent determined appropriate by the ,secretary1 if-- 7#a7 the ,secretary determines that such expansion is expected to-- 7,a7 reduce spending without reducing the quality of care2 or 7,b7 improve the quality of patient care without increasing spending2 and 7#b7 the ,secretary determines that such expansion would not deny or limit the coverage or provision of benefits for applicable individuals4 4 7b7 ,conforming amendment ,the table of sections at the beginning of such chapter1 as amended by section #abb1 is further amended by inserting after the item relating to section #agjc;,e the following new item3 #agjc;,f4 ,center for ,innovation for ,care and ,payment4 4 ,v ,other health care matters #eja4 ,authorization of appropriations for health care from ,department of ,veterans ,affairs 7a7 ,in general ,there is authorized to be appropriated to the ,secretary of ,veterans ,affairs such amounts as may be necessary to carry out the purposes set forth in subsection 7b74 7b7 ,use of amounts ,the purposes set forth in this subsection are as follows3 7#a7 ,to increase the access of veterans to care as follows3 7,a7 ,to hire primary care and specialty care physicians for employment in the ,department of ,veterans ,affairs4 7,b7 ,to hire other medical staff1 including the following3 7i7 ,physicians4 7ii7 ,nurses4 7iii7 ,social workers4 7iv7 ,mental health professionals4 7v7 ,physician assistants4 7vi7 ,other health care professionals as the ,secretary considers appropriate4 7,c7 ,to carry out the following3 7i7 ,section #gdab of title #ch1 ,united ,states ,code4 7ii7 ,section #gcjb7;e7 of such title4 7iii7 ,subchapters ,,ii and ,,vii of chapter #gf of such title4 7iv7 ,section #cja7;b77#b7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #gcjb note74 7,d7 ,to pay for expenses1 equipment1 and other costs associated with the hiring of primary care1 specialty care physicians1 and other medical staff under subparagraphs 7,a71 7,b71 and 7,c74 7#b7 ,to improve the physical infrastructure of the ,department as follows3 7,a7 ,to maintain and operate hospitals1 nursing homes1 domiciliary facilities1 and other facilities of the ,veterans ,health ,administration4 7,b7 ,to enter into contracts or hire temporary employees to repair1 alter1 or improve facilities under the jurisdiction of the ,department that are not otherwise provided for under this paragraph4 7,c7 ,to carry out leases for facilities of the ,department4 7,d7 ,to carry out minor construction projects of the ,department4 7#c7 ,to carry out sections #cjc and #dja4 7c7 ,funding plan and report 7#a7 ,in general ,not later than #ahj days after the date on which amounts are appropriated to the ,department pursuant to the authorization in subsection 7a71 the ,secretary of ,veterans ,affairs shall submit to the appropriate committees of ,congress a funding plan and report on how the ,secretary intends to obligate the amounts so appropriated and how it relates to the quadrennial ,veterans ,health ,administration review and strategic plan under section #agcj;,b7a7 of title #ch1 ,united ,states ,code1 as added by section #ajb4 7#b7 ,appropriate committees of congress defined ,in this subsection1 the term appropriate committees of ,congress means-- 7,a7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,senate2 and 7,b7 the ,committee on ,veterans' ,affairs and the ,committee on ,appropriations of the ,house of ,representatives4 #ejb4 ,appropriation of amounts for ,veterans ,choice ,program 7a7 ,in general ,there is authorized to be appropriated1 and is appropriated1 to the ,secretary of ,veterans ,affairs1 out of any funds in the ,treasury not otherwise appropriated1 #d1jjj1jjj1jjj to be deposited in the ,veterans ,choice ,fund under section #hjb of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note74 7b7 ,availability ,the amount appropriated under subsection 7a7 shall remain available until expended pursuant to section #hjb7;c77#d7 of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 as added by section #bjb4 #ejc4 ,applicability of ,directive of ,office of ,federal ,contract ,compliance ,programs 7a7 ,in general ,directive #bjad-ja of the ,office of ,federal ,contract ,compliance ,programs of the ,department of ,labor 7effective as of ,may #g1 #bjad7 shall apply to any entity entering into an agreement under section #agjc;,a or section #agde of title #ch1 ,united ,states ,code1 as amended by sections #aab and #aad1 respectively1 in the same manner as such directive applies to subcontractors under the ,,tricare program for the duration of the moratorium provided under such directive4 7b7 ,applicability period ,the directive described in subsection 7a71 and the moratorium provided under such directive1 shall not be altered or rescinded before ,may #g1 #bjai4 7c7 ,,tricare program defined ,in this section1 the term ,,tricare program has the meaning given that term in section #ajgb of title #aj1 ,united ,states ,code4 #ejd4 ,amending statutory requirements for the position of the ,chief ,officer of the ,readjustment ,counseling ,service ,section #gcji7;b77#b7 is amended-- 7#a7 in subparagraph 7,b71 by striking in the ,readjustment ,counseling ,service2 and 7#b7 in subparagraph 7,c71 by striking in the ,readjustment ,counseling ,service4 #eje4 ,authorization of certain major medical facility projects of the ,department of ,veterans ,affairs 7a7 ,authorization ,the ,secretary of ,veterans ,affairs may carry out the following major medical facility project1 to be carried out in an amount not to exceed the amount specified for that project3 ,realignment of medical facilities in ,livermore1 ,california1 in an amount not to exceed #aag1cjj1jjj4 7b7 ,authorization of appropriations for construction ,there is authorized to be appropriated to the ,secretary of ,veterans ,affairs for fiscal year #bjah or the year in which funds are appropriated for the ,construction1 ,major ,projects account1 #aag1cjj1jjj for the project authorized in subsection 7a74 7c7 ,submittal of information ,not later than #ij days after the date of the enactment of this ,act1 for the project authorized in section 7a71 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 the following information3 7#a7 ,a line item accounting of expenditures relating to construction management carried out by the ,department of ,veterans ,affairs for such project4 7#b7 ,the future amounts that are budgeted to be obligated for construction management carried out by the ,department for such project4 7#c7 ,a justification for the expenditures described in paragraph 7#a7 and the future amounts described in paragraph 7#b74 7#d7 ,any agreement entered into by the ,secretary regarding the ,army ,corps of ,engineers providing services relating to such project1 including reimbursement agreements and the costs to the ,department of ,veterans ,affairs for such services4