Sec. 101. Expanded availability of hospital care and medical services for veterans through the use of agreements with non-Department of Veterans Affairs entities
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Hospital care and medical services under chapter 17 of title 38, United States Code, shall be furnished to an eligible veteran described in subsection (b), at the election of such veteran, through agreements authorized under subsection (d), or any other law administered by the Secretary of Veterans Affairs, with entities specified in subparagraph
(B)for the furnishing of such care and services to veterans. The entities specified in this subparagraph are the following: Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ), including any physician furnishing services under such program. Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act ( 42 U.S.C. 1396d(l)(2)(B) )). The Department of Defense. The Indian Health Service. An eligible veteran who makes an election under subsection
(c)to receive hospital care or medical services under this section may select a provider of such care or services from among the entities specified in paragraph (1)(B) that are accessible to the veteran. The Secretary shall coordinate, through the Non-VA Care Coordination Program of the Department of Veterans Affairs, the furnishing of care and services under this section to eligible veterans, including by ensuring that an eligible veteran receives an appointment for such care and services within the wait-time goals of the Veterans Health Administration for the furnishing of hospital care and medical services. A veteran is an eligible veteran for purposes of this section if— as of August 1, 2014, the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of title 38, United States Code, including any such veteran who has not received hospital care or medical services from the Department and has contacted the Department seeking an initial appointment from the Department for the receipt of such care or services; or the veteran is eligible for hospital care and medical services under section 1710(e)(1)(D) of such title and is a veteran described in section 1710(e)(3) of such title; and the veteran— attempts, or has attempted, to schedule an appointment for the receipt of hospital care or medical services under chapter 17 of title 38, United States Code, but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services; resides more than 40 miles from the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran; resides— in a State without a medical facility of the Department that provides— hospital care; emergency medical services; and surgical care rated by the Secretary as having a surgical complexity of standard; and more than 20 miles from a medical facility of the Department described in clause (i); or resides in a location, other than a location in Guam, American Samoa, or the Republic of the Philippines, that is 40 miles or less from a medical facility of the Department, including a community-based outpatient clinic; and is required to travel by air, boat, or ferry to reach each medical facility described in clause
(i)that is 40 miles or less from the residence of the veteran; or faces an unusual or excessive burden in accessing each medical facility described in clause
(i)that is 40 miles or less from the residence of the veteran due to geographical challenges, as determined by the Secretary. In the case of an eligible veteran described in subsection (b)(2)(A), the Secretary shall, at the election of the eligible veteran— place such eligible veteran on an electronic waiting list described in paragraph
(2)for an appointment for hospital care or medical services the veteran has elected to receive under this section; or authorize that such care or services be furnished to the eligible veteran under this section for a period of time specified by the Secretary; and notify the eligible veteran by the most effective means available, including electronic communication or notification in writing, describing the care or services the eligible veteran is eligible to receive under this section. The electronic waiting list described in this paragraph shall be maintained by the Department and allow access by each eligible veteran via www.myhealth.va.gov or any successor website for the following purposes: To determine the place of such eligible veteran on the waiting list. To determine the average length of time an individual spends on the waiting list, disaggregated by medical facility of the Department and type of care or service needed, for purposes of allowing such eligible veteran to make an informed election under paragraph (1). The Secretary shall enter into agreements for furnishing care and services to eligible veterans under this section with entities specified in subsection (a)(1)(B). In this paragraph, the term agreement includes contracts, intergovernmental agreements, and provider agreements, as appropriate. In entering into an agreement under paragraph
(1)with an entity specified in subsection (a)(1)(B), the Secretary shall— negotiate rates for the furnishing of care and services under this section; and reimburse the entity for such care and services at the rates negotiated pursuant to clause
(i)as provided in such agreement. Except as provided in clause (ii), rates negotiated under subparagraph (A)(i) shall not be more than the rates paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act ( 42 U.S.C. 1395x(u) )) or a supplier (as defined in section 1861(d) of such Act ( 42 U.S.C. 1395x(d) )) under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) for the same care or services. The Secretary may negotiate a rate that is more than the rate paid by the United States as described in clause
(i)with respect to the furnishing of care or services under this section to an eligible veteran who resides in a highly rural area. In this clause, the term highly rural area means an area located in a county that has fewer than seven individuals residing in that county per square mile. For the furnishing of care or services pursuant to an agreement under paragraph (1), an entity specified in subsection (a)(1)(B) may not collect any amount that is greater than the rate negotiated pursuant to subparagraph (A)(i). In entering into an agreement under paragraph
(1)with an entity described in subparagraph (B), the Secretary may use the procedures, including those procedures relating to reimbursement, available for entering into provider agreements under section 1866(a) of the Social Security Act ( 42 U.S.C. 1395cc(a) ) and participation agreements under section 1842(h) of such Act ( 42 U.S.C. 1395u(h) ). During the period in which such entity furnishes care or services pursuant to this section, such entity may not be treated as a Federal contractor or subcontractor by the Office of Federal Contract Compliance Programs of the Department of Labor by virtue of furnishing such care or services. The entities described in this subparagraph are the following: In the case of the Medicare program, any provider of services that has entered into a provider agreement under section 1866(a) of the Social Security Act ( 42 U.S.C. 1395cc(a) ) and any physician or other supplier who has entered into a participation agreement under section 1842(h) of such Act ( 42 U.S.C. 1395u(h) ); and In the case of the Medicaid program, any provider participating under a State plan under title XIX of such Act ( 42 U.S.C. 1396 et seq. ). The Secretary shall provide to any entity with which the Secretary has entered into an agreement under paragraph
(1)the following: Information on applicable policies and procedures for submitting bills or claims for authorized care or services furnished to eligible veterans under this section. Access to a telephone hotline maintained by the Department that such entity may call for information on the following: Procedures for furnishing care and services under this section. Procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services. Whether particular care or services under this section are authorized, and the procedures for authorization of such care or services. Before receiving hospital care or medical services under this section, an eligible veteran shall provide to the Secretary information on any health-care plan described in paragraph
(4)under which the eligible veteran is covered. Notwithstanding section 5701 of title 38, United States Code, for purposes of furnishing hospital care or medical services to an eligible veteran under this section, the Secretary shall disclose to the entity specified in paragraph (1)(B) of subsection
(a)with which the Secretary has entered into an agreement described in such subsection— whether the eligible veteran is covered under a health-care plan described in paragraph (4); and whether the hospital care or medical services sought by the eligible veteran is for a medical condition that is related to a non-service-connected disability described in paragraph (3)(C). If an eligible veteran is covered under a health-care plan described in paragraph
(4)and receives hospital care or medical services for a non-service-connected disability described in subparagraph (C), such health-care plan shall be primarily responsible for paying for such care or services, to the extent such care or services is covered by such health-care plan, and the Secretary shall be secondarily responsible for paying for such care or services in accordance with subparagraph (B)(ii). In a case in which the Secretary is secondarily responsible for paying for hospital care or medical services as described in subparagraph (A)— the health care provider that furnishes such care or services pursuant to an agreement described in subsection
(a)shall be responsible for seeking reimbursement for the cost of such care or services from the health-care plan described in paragraph
(4)under which the eligible veteran is covered; and the Secretary shall be responsible for promptly paying only the amount that is not covered by such health-care plan, except that such responsibility for payment may not exceed the rate determined for such care or services pursuant to subsection (d)(2). A non-service-connected disability described in this subsection is a non-service-connected disability (as defined in section 101 of title 38, United States Code)— that is incurred incident to a veteran’s employment and that is covered under a workers’ compensation law or plan that provides for payment for the cost of health care and services provided to the veteran by reason of the disability; that is incurred as the result of a motor vehicle accident to which applies a State law that requires the owners or operators of motor vehicles registered in that State to have in force automobile accident reparations insurance; that is incurred as the result of a crime of personal violence that occurred in a State, or a political subdivision of a State, in which a person injured as the result of such a crime is entitled to receive health care and services at such State’s or subdivision’s expense for personal injuries suffered as the result of such crime; that is incurred by a veteran— who does not have a service-connected disability; and who is entitled to care (or payment of the expenses of care) under a health-care plan; or for which care and services are furnished under this section to a veteran who— has a service-connected disability; and is entitled to care (or payment of the expenses of care) under a health-care plan. A health-care plan described in this paragraph— is an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement not administered by the Secretary of Veterans Affairs, under which health services for individuals are provided or the expenses of such services are paid; and does not include any such policy, contract, agreement, or similar arrangement pursuant to title XVIII or XIX of the Social Security Act ( 42 U.S.C. 1395 et seq. ) or chapter 55 of title 10, United States Code. For purposes of receiving care and services under this section, the Secretary shall, not later than 90 days after the date of the enactment of this Act, issue to each veteran described in subsection (b)(1) a card that may be presented to a health care provider to facilitate the receipt of care or services under this section. Each card issued under paragraph
(1)shall be known as a Veterans Choice Card . Each Veterans Choice Card issued to a veteran under paragraph
(1)shall include the following: The name of the veteran. An identification number for the veteran that is not the social security number of the veteran. The contact information of an appropriate office of the Department for health care providers to confirm that care or services under this section are authorized for the veteran. Contact information and other relevant information for the submittal of claims or bills for the furnishing of care or services under this section. The following statement: This card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone number specified on this card to ensure that treatment has been authorized. . Upon issuing a Veterans Choice Card to a veteran, the Secretary shall provide the veteran with information clearly stating the circumstances under which the veteran may be eligible for care or services under this section. The Secretary shall provide information to a veteran about the availability of care and services under this section in the following circumstances: In the case of a veteran described in subsection (b)(1)(B), when the veteran enrolls in the patient enrollment system of the Department under section 1705 of title 38, United States Code. When the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the Department but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services. When the veteran becomes eligible for hospital care or medical services under this section under subparagraph (B), (C), or
(D)of subsection (b)(2). In carrying out this section, the Secretary shall ensure that, at the election of an eligible veteran who receives hospital care or medical services from a health care provider in an episode of care under this section, the veteran receives such hospital care and medical services from such health care provider through the completion of the episode of care (but for a period not exceeding 60 days), including all specialty and ancillary services deemed necessary as part of the treatment recommended in the course of such hospital care or medical services. To be eligible to furnish care or services under this section, a health care provider must— maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the Department, as determined by the Secretary for purposes of this section; and submit, not less frequently than once each year during the period in which the Secretary is authorized to carry out this section pursuant to subsection (p), verification of such licenses and credentials maintained by such health care provider. The Secretary shall require an eligible veteran to pay a copayment for the receipt of care or services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department pursuant to chapter 17 of title 38, United States Code. The amount of a copayment charged under paragraph
(1)may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department pursuant to chapter 17 of title 38, United States Code. A health care provider that furnishes care or services to an eligible veteran under this section shall collect the copayment required under paragraph
(1)from such eligible veteran at the time of furnishing such care or services. The Secretary shall provide for an efficient nationwide system for processing and paying bills or claims for authorized care and services furnished to eligible veterans under this section. Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe regulations for the implementation of such system. The Chief Business Office of the Veterans Health Administration shall oversee the implementation and maintenance of such system. The Secretary shall ensure that such system meets such goals for accuracy of payment as the Secretary shall specify for purposes of this section. 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 quarterly report on the accuracy of such system. Each report required by clause
(i)shall include the following: A description of the goals for accuracy for such system specified by the Secretary under subparagraph (A). An assessment of the success of the Department in meeting such goals during the quarter covered by the report. The Secretary shall submit each report required by clause
(i)not later than 20 days after the end of the quarter covered by the report. The Secretary shall ensure that any health care provider that furnishes care or services under this section to an eligible veteran submits to the Department any medical record related to the care or services provided to such eligible veteran by such health care provider for inclusion in the electronic medical record of such eligible veteran maintained by the Department upon the completion of the provision of such care or services to such eligible veteran. Any medical record submitted to the Department under paragraph
(1)shall, to the extent possible, be in an electronic format. The Secretary shall implement a mechanism to track any missed appointments for care or services under this section by eligible veterans to ensure that the Department does not pay for such care or services that were not furnished to an eligible veteran. Not later than 90 days after the date of the enactment of this Act, the Secretary shall prescribe interim final regulations on the implementation of this section and publish such regulations in the Federal Register. Not later than 30 days after the date on which the Secretary determines that 75 percent of the amounts deposited in the Veterans Choice Fund established by section 802 have been exhausted, the Inspector General of the Department shall submit to the Secretary a report on the results of an audit of the care and services furnished under this section to ensure the accuracy and timeliness of payments by the Department for the cost of such care and services, including any findings and recommendations of the Inspector General. The Secretary may not use the authority under this section to furnish care and services after the date specified in paragraph (2). The date specified in this paragraph is the date on which the Secretary has exhausted all amounts deposited in the Veterans Choice Fund established by section 802, or the date that is 3 years after the date of the enactment of this Act, whichever occurs first. The Secretary shall publish such date in the Federal Register and on an Internet website of the Department available to the public not later than 30 days before such date. Not later than 90 days after the publication of the interim final regulations under subsection (n), 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 the furnishing of care and services under this section that includes the following: The number of eligible veterans who have received care or services under this section. A description of the types of care and services furnished to eligible veterans under this section. Not later than 30 days after the date on which the Secretary determines that 75 percent of the amounts deposited in the Veterans Choice Fund established by section 802 have been exhausted, 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 the furnishing of care and services under this section that includes the following: The total number of eligible veterans who have received care or services under this section, disaggregated by— eligible veterans described in subsection (b)(2)(A); eligible veterans described in subsection (b)(2)(B); eligible veterans described in subsection (b)(2)(C); and eligible veterans described in subsection (b)(2)(D). A description of the types of care and services furnished to eligible veterans under this section. An accounting of the total cost of furnishing care and services to eligible veterans under this section. The results of a survey of eligible veterans who have received care or services under this section on the satisfaction of such eligible veterans with the care or services received by such eligible veterans under this section. An assessment of the effect of furnishing care and services under this section on wait times for appointments for the receipt of hospital care and medical services from the Department. An assessment of the feasibility and advisability of continuing furnishing care and services under this section after the termination date specified in subsection (p). Nothing in this section shall be construed to alter the process of the Department for filling and paying for prescription medications. Except as provided in paragraph (2), in this section, the term wait-time goals of the Veterans Health Administration means not more than 30 days from the date on which a veteran requests an appointment for hospital care or medical services from the Department. If the Secretary submits to Congress, not later than 60 days after the date of the enactment of this Act, a report stating that the actual wait-time goals of the Veterans Health Administration are different from the wait-time goals specified in paragraph (1)— for purposes of this section, the wait-time goals of the Veterans Health Administration shall be the wait-time goals submitted by the Secretary under this paragraph; and the Secretary shall publish such wait-time goals in the Federal Register and on an Internet website of the Department available to the public.
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Sec. 101
Expanded availability of hospital care and medical services for veterans through the use of agreements with non-Department of Veterans Affairs entities
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