,,ii  #aae? ,,congress  #a/ ,session    
,s4 #bbci  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,decemb] #ad1 #bjag    
,ms4 ,/ab5[ introduc$ ! foll[+ bill2 :i*
 0 read twice & ref]r$ to ! ,committee  
on ,vet]ans' ,affairs  ,a ,,bill  ,to   
am5d ! ,vet]ans ,access1 ,*oice1 &      
,acc\ntability ,act ( #bjad to improve !
 s*$ul+ ( appo9tm5ts1 ! acc\ntability ( 
?ird p>ty adm9i/rators1 & paym5t to     
provid]s "u su* ,act1 & = o!r purposes4 
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,vet]ans ,des]ve ,bett] ,act4  #b4    
,paym5t to provid]s "u ,vet]ans ,*oice  
,program1 s*$ul+ ( appo9tm5ts1 &        
acc\ntability ( ?ird p>ty adm9i/rators  
"u su* program ,section #aja ( !        
,vet]ans ,access1 ,*oice1 &             
,acc\ntability ,act ( #bjad 7,public    
,law #aac-adf2 #ch ,u4,s4,c4 #agja note7
 is am5d$ by add+ at ! end ! foll[+ new 
subsections3  7u7 ,prompt paym5t  7#a7  
,paym5t ( claims  7,a7 ,9 g5]al ,not)/&+
 any o!r provision ( ?is section or any 
o!r provision ( law1 ! ,secret>y %all   

pay = hospital c>e or m$ical s]vices    
furni%$ by a heal? c>e entity or provid]
 "u ?is section )9 #de cal5d> days ^u   
receipt ( a clean pap] claim or #cj     
cal5d> days ^u receipt ( a clean        
electronic claim4  7,b7 ,d5ial ,if a    
claim is d5i$1 ! ,secret>y %all1 )9 #de 
cal5d> days ( d5ial = a pap] claim & #cj
 cal5d> days ( d5ial = an electronic    
claim1 notify ! heal? c>e entity or     
provid] ( ! reason = d5y+ ! claim & :at1
 if any1 additional in=mation is requir$
 to process ! claim4  7,c7 ,additional  
in=mation ,^u ! receipt ( additional    
in=mation describ$ 9 subp>agraph 7,b7 ) 
respect to a d5i$ claim1 ! ,secret>y    
%all ensure t ! claim is paid1 d5i$1 or 
o!rwise adjudicat$ )9 #cj cal5d> days f 
! receipt ( ! reque/$ in=mation4  7,d7  
,invoice basis ,?is subsection %all only
 apply to paym5ts made on an invoice    
basis & %all n apply to capitation or   
o!r =ms ( p]iodic paym5t4  7#b7         
,submittal ( claims  ,a heal? c>e entity
 or provid] t furni%es hospital c>e or  

m$ical s]vices "u ?is section %all      
submit to ! ,secret>y a claim = paym5t =
 furni%+ ! hospital c>e or m$ical       
s]vices n lat] ?an #ahj days aft] ! date
 on :i* ! heal? c>e entity or provid]   
furni%$ ! hospital c>e or m$ical        
s]vices4  7#c7  ,fraudul5t claims  7,a7 
,9 g5]al ,sections #cgbi ?r\gh #cgcc (  
title #ca1 ,unit$ ,/ates ,code1 %all    
apply to fraudul5t claims = paym5t      
submitt$ to ! ,secret>y by a heal? c>e  
entity or provid] "u ?is section4  7,b7 
,preclusion ( c]ta9 provid]s ,pursuant  
to regulations prescrib$ by ! ,secret>y1
 ! ,secret>y %all b> a heal? c>e entity 
or provid] f furni%+ hospital c>e or    
m$ical s]vices "u ?is section if !      
,secret>y det]m9es ! heal? c>e entity or
 provid] has submitt$ to ! ,secret>y    
fraudul5t heal? c>e claims = paym5t by !
 ,secret>y4  7#d7  ,ov]due claims  7,a7 
,9 g5]al ,any claim t has n be5 d5i$ )  
notice1 made p5d+ ) notice1 or paid to a
 heal? c>e entity or provid] by !       
,secret>y %all be ov]due if ! notice or 

paym5t is n receiv$ by ! heal? c>e      
entity or provid] )9 ! "t p]iods        
specifi$ 9 p>agraph 7#a74  7,b7 ,int]e/ 
7i7 ,9 g5]al ,if a claim is ov]due "u   
?is p>agraph1 ! ,secret>y may1 "u !     
requirem5ts e/abli%$ by p>agraph 7#a7 & 
consi/5t ) ! provisions ( *apt] #ci (   
title #ca1 ,unit$ ,/ates ,code 7commonly
 ref]r$ to z ! ,prompt ,paym5t ,act71   
require t int]e/ be paid on clean       
claims4  7ii7 ,computation ,int]e/ paid 
"u clause 7i7 %all be comput$ at ! rate 
( int]e/ e/abli%$ by ! ,secret>y ( !    
,treasury "u section #cijb ( title #ca1 
,unit$ ,/ates ,code1 & publi%$ 9 !      
,f$]al ,regi/]4  7,c7 ,report ,n less   
frequ5tly ?an annually1 ! ,secret>y %all
 submit to ,congress a report on paym5t 
( ov]due claims "u ?is p>agraph1        
disaggregat$ by pap] & electronic       
claims1 t includes ! foll[+3  7i7 ,!    
am\nt paid 9 ov]due claims "u ?is       
p>agraph1 disaggregat$ by ! am\nt ( !   
ov]due claim & ! am\nt ( int]e/ paid on 
su* ov]due claim4  7ii7 ,! numb] ( su*  

ov]due claims & ! av]age numb] ( days   
late ea* claim 0 paid1 disaggregat$ by  
facility ( ! ,dep>tm5t & ,vet]ans       
,integrat$ ,s]vice ,network region4     
7#e7  ,ov]paym5t  7,a7 ,9 g5]al ,except 
z provid$ 9 subp>agraph 7,b71 !         
,secret>y %all d$uct ! am\nt ( any      
ov]paym5t f paym5ts due a heal? c>e     
entity or provid] "u ?is section4  7,b7 
,notification ( "r ,to dispute  7i7 ,9  
g5]al ,d$uctions may n be made "u ?is   
p>agraph unless ! ,secret>y has made    
reasonable ef=ts to notify a heal? c>e  
entity or provid] ( ! "r to dispute !   
exi/5ce or am\nt ( su* indebt$ness & !  
"r to reque/ a compromise ( su*         
indebt$ness4  7ii7 ,det]m9ation ,!      
,secret>y %all make a det]m9ation )     
respect to any dispute or reque/ "u     
clause 7i7 prior to d$uct+ any ov]paym5t
 "u ?is p>agraph unless ! "t requir$ to 
make su* a det]m9ation be=e mak+ any    
d$uctions w\ld jeop>dize ! ,secret>y's  
ability to recov] ! full am\nt ( su*    
indebt$ness4  7#f7  ,in=mation &        

docum5tation requir$  7,a7 ,9 g5]al ,!  
,secret>y %all provide to all heal? c>e 
entities or provid]s furni%+ hospital   
c>e or m$ical s]vices "u ?is section a  
li/ ( in=mation & docum5tation t is     
requir$ to e/abli% a clean claim "u ?is 
subsection4  7,b7  ,consultation ) heal?
 c>e entities ,! ,secret>y %all consult 
) entities 9 ! heal? c>e indu/ry1 9 !   
public & private sector1 to det]m9e !   
in=mation & docum5tation to include 9 ! 
li/ "u subp>agraph 7,a74  7,c7          
,notification ( modifications ,if !     
,secret>y modifies ! in=mation &        
docum5tation includ$ 9 ! li/ "u         
subp>agraph 7,a71 ! ,secret>y %all      
notify all heal? c>e entities or        
provid]s describ$ 9 su* subp>agraph n   
lat] ?an #cj days be=e su* modifications
 take effect4  7#g7 ,process+ ( claims  
,9 process+ a claim = comp5sation =     
hospital c>e or m$ical s]vices furni%$  
by a heal? c>e entity or provid] "u ?is 
section1 ! ,secret>y %all act ?r\gh--   
7,a7 a non-,dep>tm5t entity t has ent]$ 

into an agreem5t ) ! ,secret>y "u ?is   
section2 or  7,b7 a non-,dep>tm5t entity
 t specializes 9 process+ su* claims =  
o!r ,f$]al ag5cy heal? c>e sy/ems4  7#h7
 ,treatm5t ( c]ta9 out/&+ claims  7,a7  
,report ,n lat] ?an #cj days aft] ! date
 ( ! enactm5t ( ! ,vet]ans ,des]ve      
,bett] ,act1 ! ,secret>y %all submit to 
! appropriate committees ( ,congress a  
report on ! numb] ( claims = paym5t =   
hospital c>e & m$ical s]vices furni%$ to
 eligible vet]ans "u ?is section t are  
out/&+ z ( ! date ( ! submittal ( !     
report4  7,b7 ,outrea* to provid]s      
,not)/&+ any o!r provision ( ?is        
section1 ) respect to ea* heal? c>e     
entity or provid] t has an out/&+ claim 
= paym5t = hospital c>e & m$ical s]vices
 furni%$ to eligible vet]ans "u ?is     
section z ( ! date ( ! enactm5t ( !     
,vet]ans ,des]ve ,bett] ,act1 n lat] ?an
 #de days aft] su* date ( enactm5t1 !   
,secret>y %all ei!r pay ! claim1 d5y !  
claim1 or reque/ additional in=mation   
reg>d+ ! claim4  7#i7  ,def9itions  ,9  

?is subsection3 7,a7 ,! t]m appropriate 
committees ( ,congress means--  7i7 !   
,committee on ,vet]ans' ,affairs & !    
,committee on ,appropriations ( !       
,s5ate2 &  7ii7 ! ,committee on         
,vet]ans' ,affairs & ! ,committee on    
,appropriations ( ! ,h\se (             
,repres5tatives4  7,b7 ,! t]m clean     
electronic claim means ! transmission ( 
data = purposes ( paym5t ( cov]$ heal?  
c>e exp5ses t is submitt$ to ! ,secret>y
 :i* conta9s sub/antially all ( !       
requir$ data elem5ts necess>y = accurate
 adjudication1 )\t obta9+ additional    
in=mation f ! heal? c>e entity or       
provid] t furni%$ ! c>e or s]vice1      
submitt$ 9 su* =mat z prescrib$ by !    
,secret>y 9 regulations = ! purpose (   
pay+ claims = c>e or s]vices4  7,c7 ,!  
t]m clean pap] claim means a pap] claim 
= paym5t ( cov]$ heal? c>e exp5ses t is 
submitt$ to ! ,secret>y :i* conta9s     
sub/antially all ( ! requir$ data       
elem5ts necess>y = accurate             
adjudication1 )\t obta9+ additional     

in=mation f ! heal? c>e entity or       
provid] t furni%$ ! c>e or s]vice1      
submitt$ 9 su* =mat z prescrib$ by !    
,secret>y 9 regulations = ! purpose (   
pay+ claims = c>e or s]vices4  7,d7 ,!  
t]m fraudul5t claims-- 7i7 means !      
int5tional & delib]ate misrepres5tation 
( a mat]ial fact or facts by a heal? c>e
 entity or provid] made to induce !     
,secret>y to pay a claim t 0 n legally  
payable to t entity or provid]2 &  7ii7 
does n include a good fai? int]pretation
 by a heal? c>e entity or provid] (     
utilization1 m$ical necessity1 cod+1 &  
bill+ requirem5ts ( ! ,secret>y4  7,e7  
,! t]m heal? c>e entity or provid] means
 any heal? c>e entity or provid] t is an
 entity describ$ 9 subsection           
7a77#a77;,b71 exclud+ any ,f$]al heal?  
c>e entity or provid]4  7v7 ,in=mation  
on s*$ul+ appo9tm5ts ,! ,secret>y %all  
provide to ea* eligible vet]an :o seeks 
an appo9tm5t = c>e or s]vices "u ?is    
section ! foll[+3  7#a7 ,in=mation on ! 
"t requir$ = a vet]an to make an        

appo9tm5t = su* c>e or s]vices "u ?is   
section 9 ! region 9 :i* ! vet]an       
resides4  7#b7 ,) respect to appo9tm5ts 
made ?r\gh ?ird p>ty adm9i/rators-- 7,a7
 in=mation on :at w happ5 if ! ?ird p>ty
 adm9i/rator _c s*$ule an appo9tm5t = ! 
provision ( su* c>e or s]vices2  7,b7 a 
li/ ( o!r heal? c>e provid]s 9 ! region 
9 :i* ! vet]an resides t are )9 !       
network ( ! ?ird p>ty adm9i/rator2 &    
7,c7 in=mation on h[ ! vet]an c file ) !
 ,secret>y a compla9t conc]n+ ! h&l+ (  
an appo9tm5t by ! ?ird p>ty adm9i/rator4
  7w7 ,requirem5ts ( ?ird p>ty          
adm9i/rators  7#a7 ,appo9tm5t tim+ ,!   
,secret>y %all ensure t ea* contract ) a
 ?ird p>ty adm9i/rator requires ! ?ird  
p>ty adm9i/rator to s*$ule an appo9tm5t 
= c>e or s]vices "u ?is section = an    
eligible vet]an n lat] ?an five days    
aft] ! eligible vet]an elects to receive
 su* c>e or s]vices "u ?is section4     
7#b7 ,track+ ( appo9tm5ts ,! ,secret>y  
%all track all appo9tm5ts = c>e &       
s]vices "u ?is section t are s*$ul$     

directly ?r\gh a ?ird p>ty adm9i/rator4 
7#c7 ,foll[-up ,! ,secret>y %all foll[  
up ) a ?ird p>ty adm9i/rator reg>d+ any 
appo9tm5t = c>e or s]vices "u ?is       
section t is p5d+ to be s*$ul$ by ! ?ird
 p>ty adm9i/rator = m ?an #e days to    
det]m9e ! reason = ! delay 9 s*$ul+ !   
appo9tm5t4  7#d7 ,report on ov]due      
appo9tm5ts ,! ,secret>y %all require ea*
 ?ird p>ty adm9i/rator to submit to !   
,secret>y1 n lat] ?an #cj days aft] !   
date ( ! enactm5t ( ! ,vet]ans ,des]ve  
,bett] ,act1 a li/ ( ! appo9tm5ts t1 z (
 ! submittal ( ! report1 h be5 p5d+     
s*$ul+ by ! ?ird p>ty adm9i/rator = a   
p]iod ( m ?an #ae days4  4