,,ii  #aaith ,,congress  #ast ,session  
,s4 #ahfh  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #bb1 #bjbe
 ,mr4 ,cramer 7for himself and ,mr4     
,sheehy7 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 expand access by      
veterans to critical access hospitals   
and affiliated clinics under the        
,veterans ,community ,care ,program1 and
 for other purposes4  #a4  ,short title 
,this ,act may be cited as the ,critical
 ,access for ,veterans ,care ,act4  #b4 
,expansion of access by veterans to     
critical access hospitals and affiliated
 clinics under ,veterans ,community     
,care ,program  7a7  ,in general        
,subsection 7d77#a7 of section #agjc of 
title #ch1 ,united ,states ,code1 is    
amended--  7#a7 in subparagraph 7,d71 by
 striking 2 or and inserting a          
semicolon2  7#b7 in subparagraph 7,e71  
by striking the period at the end and   

inserting 2 or2 and  7#c7 by adding at  
the end the following new subparagraph3 
7,f7 with respect to care or services   
sought by a covered veteran at a        
critical access hospital or             
provider-based rural health clinic      
affiliated with such hospital 7including
 any care or services sought from a     
health care provider specified in       
subsection 7c7 located in the           
surrounding community of such hospital  
or clinic due to a referral from such   
hospital or clinic71 the veteran resides
 within #ce miles of such hospital or   
clinic4  4  7b7  ,prior authorization   
and referral  ,such section is further  
amended-- 7#a7 in subsection 7a77#c71 by
 striking ,a covered veteran and        
inserting ,except as provided in        
subsection 7d77#e71 a covered veteran2  
and  7#b7 in subsection 7d71 by adding  
at the end the following new paragraph3 
7#e7 ,the ,secretary may not require a  
covered veteran to receive authorization
 or a referral prior to the receipt of  

care or services under paragraph        
7#a77;,f74  4  7c7  ,payment rate and   
claims for care and services            
,subsection 7i7 of such section is      
amended by adding at the end the        
following new paragraph3  7#g7  7,a7    
,with respect to care or services       
furnished under this section--  7i7 at a
 critical access hospital1 including    
pursuant to subsection 7d77#a77;,f71 the
 critical access hospital rate          
established under the ,medicare program 
under title ,,xviii of the ,social      
,security ,act 7#db ,u4,s4,c4 #acie et  
seq47 shall apply instead of the        
service-based rate2 and  7ii7 at a      
provider-based rural health clinic      
affiliated with such hospital1 including
 pursuant to subsection 7d77#a77;,f71   
the rate specified under section #ahcc  
of the ,social ,security ,act 7#db      
,u4,s4,c4 #aciel7 shall apply4  7,b7    
,claims for covered veterans receiving  
care under subsection 7d77#a77;,f7 shall
 include an identifier denoting the care

 or services provided under such        
subsection and shall be reimbursed at   
the cost-based level under the ,medicare
 program4  7,c7 ,the ,secretary1 in     
consultation with the ,administrator of 
the ,centers for ,medicare  ,medicaid   
,services1 may furnish additional       
guidance regarding the claims process   
under this paragraph in accordance with 
the best practices of medicare          
administrative contractors 7as defined  
in section #ahgd;,a7a77#c7 of the       
,social ,security ,act 7#db ,u4,s4,c4   
#aciekk-#a7;a77#c777 in processing      
cost-based reimbursement for services   
furnished at critical access hospitals  
or provider-based rural health clinics  
affiliated with such hospitals4  7,d7   
,claims for covered veterans receiving  
care under subsection 7d77#a77;,f7 shall
 be reviewed and payment shall be issued
 in accordance with the findings of such
 review not later than #fj days after   
the submission of the claim4  4  7d7    
,definitions  ,subsection 7o7 of such   

section is amended-- 7#a7 by            
redesignating paragraph 7#b7 as         
paragraph 7#c72 and  7#b7 by inserting  
after paragraph 7#a7 the following new  
paragraph 7#b73  7#b7 ,the term critical
 access hospital has the meaning given  
that term in section #ahfa7mm7 of the   
,social ,security ,act 7#db ,u4,s4,c4   
#aciex7mm774  4  7e7  ,report  7#a7  ,in
 general  ,not later than one year after
 the date of the enactment of this ,act1
 the ,secretary of ,veterans ,affairs   
shall submit to ,congress a report on   
third party administrators and community
 care providers concerning the          
implementation of the amendments made by
 this section1 including timely approval
 and payment of claims under section    
#agjc7;d77#a77;,f71 as added by         
subsection 7a71 and overall user        
experience associated with care or      
services provided pursuant to such      
amendments4  7#b7  ,definitions  ,in    
this subsection3 7,a7 ,community care   
provider ,the term community care       

provider means a health care provider   
specified in paragraph 7#a7 or 7#e7 of  
section #agjc7;c7 of title #ch1 ,united 
,states ,code4  7,b7  ,third party      
administrator  ,the term third party    
administrator means an entity that      
manages a provider network and performs 
administrative services related to such 
network within the ,veterans ,community 
,care ,program under section #agjc of   
title #ch1 ,united ,states ,code4