,,ii #aaeth ,,congress #ast ,session ,s4 #bbci ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ad1 #bjag ,ms4 ,stabenow introduced the following bill2 which was read twice and referred to the ,committee on ,veterans' ,affairs ,a ,,bill ,to amend the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad to improve the scheduling of appointments1 the accountability of third party administrators1 and payment to providers under such ,act1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,veterans ,deserve ,better ,act4 #b4 ,payment to providers under ,veterans ,choice ,program1 scheduling of appointments1 and accountability of third party administrators under such program ,section #aja of the ,veterans ,access1 ,choice1 and ,accountability ,act of #bjad 7,public ,law #aac-adf2 #ch ,u4,s4,c4 #agja note7 is amended by adding at the end the following new subsections3 7u7 ,prompt payment 7#a7 ,payment of claims 7,a7 ,in general ,notwithstanding any other provision of this section or any other provision of law1 the ,secretary shall pay for hospital care or medical services furnished by a health care entity or provider under this section within #de calendar days upon receipt of a clean paper claim or #cj calendar days upon receipt of a clean electronic claim4 7,b7 ,denial ,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 ,additional information ,upon the receipt of additional information described in subparagraph 7,b7 with respect to a denied claim1 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 ,invoice basis ,this subsection shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment4 7#b7 ,submittal of claims ,a health care entity or provider that furnishes hospital care or medical services under this section shall submit to the ,secretary a claim for payment for furnishing the hospital care or medical services not later than #ahj days after the date on which the health care entity or provider furnished the hospital care or medical services4 7#c7 ,fraudulent claims 7,a7 ,in general ,sections #cgbi through #cgcc of title #ca1 ,united ,states ,code1 shall apply to fraudulent claims for payment submitted to the ,secretary by a health care entity or provider under this section4 7,b7 ,preclusion of certain providers ,pursuant to regulations prescribed by the ,secretary1 the ,secretary shall bar a health care entity or provider from furnishing hospital care or medical services under this section if the ,secretary determines the health care entity or provider has submitted to the ,secretary fraudulent health care claims for payment by the ,secretary4 7#d7 ,overdue claims 7,a7 ,in general ,any claim that has not been denied with notice1 made pending with notice1 or paid to a health care entity or provider by the ,secretary shall be overdue if the notice or payment is not received by the health care entity or provider within the time periods specified in paragraph 7#a74 7,b7 ,interest 7i7 ,in general ,if a claim is overdue under this paragraph1 the ,secretary may1 under the requirements established by paragraph 7#a7 and consistent with the provisions of chapter #ci of title #ca1 ,united ,states ,code 7commonly referred to as the ,prompt ,payment ,act71 require that interest be paid on clean claims4 7ii7 ,computation ,interest paid under clause 7i7 shall be computed at the rate of interest established by the ,secretary of the ,treasury under section #cijb of title #ca1 ,united ,states ,code1 and published in the ,federal ,register4 7,c7 ,report ,not less frequently than annually1 the ,secretary shall submit to ,congress a report on payment of overdue claims under this paragraph1 disaggregated by paper and electronic claims1 that includes the following3 7i7 ,the amount paid in overdue claims under this paragraph1 disaggregated by the amount of the overdue claim and the amount of interest paid on such overdue claim4 7ii7 ,the number of such overdue claims and the average number of days late each claim was paid1 disaggregated by facility of the ,department and ,veterans ,integrated ,service ,network region4 7#e7 ,overpayment 7,a7 ,in general ,except as provided in subparagraph 7,b71 the ,secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this section4 7,b7 ,notification of right ,to dispute 7i7 ,in general ,deductions may not be made under this paragraph 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 7ii7 ,determination ,the ,secretary shall make a determination with respect to any dispute or request under clause 7i7 prior to deducting any overpayment under this paragraph 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 7#f7 ,information and documentation required 7,a7 ,in general ,the ,secretary shall provide to all health care entities or providers furnishing hospital care or medical services under this section a list of information and documentation that is required to establish a clean claim under this subsection4 7,b7 ,consultation with health care entities ,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 subparagraph 7,a74 7,c7 ,notification of modifications ,if the ,secretary modifies the information and documentation included in the list under subparagraph 7,a71 the ,secretary shall notify all health care entities or providers described in such subparagraph not later than #cj days before such modifications take effect4 7#g7 ,processing of claims ,in processing a claim for compensation for hospital care or medical services furnished by a health care entity or provider under this section1 the ,secretary shall act through-- 7,a7 a non-,department entity that has entered into an agreement with the ,secretary under this section2 or 7,b7 a non-,department entity that specializes in processing such claims for other ,federal agency health care systems4 7#h7 ,treatment of certain outstanding claims 7,a7 ,report ,not later than #cj days after the date of the enactment of the ,veterans ,deserve ,better ,act1 the ,secretary shall submit to the appropriate committees of ,congress a report on the number of claims for payment for hospital care and medical services furnished to eligible veterans under this section that are outstanding as of the date of the submittal of the report4 7,b7 ,outreach to providers ,notwithstanding any other provision of this section1 with respect to each health care entity or provider that has an outstanding claim for payment for hospital care and medical services furnished to eligible veterans under this section as of the date of the enactment of the ,veterans ,deserve ,better ,act1 not later than #de days after such date of enactment1 the ,secretary shall either pay the claim1 deny the claim1 or request additional information regarding the claim4 7#i7 ,definitions ,in this subsection3 7,a7 ,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 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 health care 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 health care 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-- 7i7 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 entity or provider2 and 7ii7 does 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 means any health care entity or provider that is an entity described in subsection 7a77#a77;,b71 excluding any ,federal health care entity or provider4 7v7 ,information on scheduling appointments ,the ,secretary shall provide to each eligible veteran who seeks an appointment for care or services under this section the following3 7#a7 ,information on the time required for a veteran to make an appointment for such care or services under this section in the region in which the veteran resides4 7#b7 ,with respect to appointments made through third party administrators-- 7,a7 information on what will happen if the third party administrator cannot schedule an appointment for the provision of such care or services2 7,b7 a list of other health care providers in the region in which the veteran resides that are within the network of the third party administrator2 and 7,c7 information on how the veteran can file with the ,secretary a complaint concerning the handling of an appointment by the third party administrator4 7w7 ,requirements of third party administrators 7#a7 ,appointment timing ,the ,secretary shall ensure that each contract with a third party administrator requires the third party administrator to schedule an appointment for care or services under this section for an eligible veteran not later than five days after the eligible veteran elects to receive such care or services under this section4 7#b7 ,tracking of appointments ,the ,secretary shall track all appointments for care and services under this section that are scheduled directly through a third party administrator4 7#c7 ,follow-up ,the ,secretary shall follow up with a third party administrator regarding any appointment for care or services under this section that is pending to be scheduled by the third party administrator for more than #e days to determine the reason for the delay in scheduling the appointment4 7#d7 ,report on overdue appointments ,the ,secretary shall require each third party administrator to submit to the ,secretary1 not later than #cj days after the date of the enactment of the ,veterans ,deserve ,better ,act1 a list of the appointments that1 as of the submittal of the report1 have been pending scheduling by the third party administrator for a period of more than #ae days4 4