Sec. 301. Expanded availability of hospital care and medical services for veterans through the use of contracts
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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 contracts 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. ). 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 elects to receive care and services under this section may select the provider of such care and services from among any source of provider of such care and services through an entity specified in paragraph (1)(B) that is 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 current 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— 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; or the veteran is enrolled in such system, 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; and the veteran— attempts, or has attempted under paragraph (1)(B), 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 current wait-time goals of the Veterans Health Administration for the furnishing of such care or services; and elects, and is authorized, to be furnished such care or services pursuant to subsection (c)(2); resides more than 40 miles from the nearest medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran; or 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). If the Secretary confirms that an appointment for an eligible veteran described in subsection (b)(2)(A) for the receipt of hospital care or medical services under chapter 17 of title 38, United States Code, is unavailable within the current wait-time goals of the Department for the furnishing of such care or services, the Secretary shall, at the election of the eligible veteran— place such eligible veteran on an electronic waiting list described in paragraph
(2)for such an appointment; or authorize that such care and services be furnished to the eligible veteran under this section for a period of time specified by the Secretary; and send a letter to the eligible veteran describing the care and 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 contracts with health care providers that are participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) to furnish care and services to eligible veterans under this section. In entering into a contract under this subsection, the Secretary shall— negotiate rates for the furnishing of care and services under this section; and reimburse the health care provider for such care and services at the rates negotiated pursuant to clause
(i)as provided in such contract. 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 and 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 if the Secretary determines that there is no health care provider that will provide such care or services to such eligible veteran at the rate required under such clause— within the current wait-time goals of the Veterans Health Administration for the furnishing of such care or services; and at a location not more than 40 miles from the residence of such eligible veteran. For the furnishing of care and services pursuant to a contract under this section, a health care provider may not collect any amount that is greater than the rate negotiated pursuant to subparagraph (A)(i). The Secretary shall provide to any health care provider with which the Secretary has entered into a contract under paragraph
(1)the following: Information on applicable policies and procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section. Access to a telephone hotline maintained by the Department that such health care provider 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. For purposes of receiving care and services under this section, the Secretary shall issue to each eligible veteran a card that the eligible veteran shall present to a health care provider that is eligible to furnish care and services under this section before receiving such care and services. Each card issued under paragraph
(1)shall be known as a Choice Card . Each Choice Card issued to an eligible veteran under paragraph
(1)shall include the following: The name of the eligible veteran. An identification number for the eligible veteran that is not the social security number of the eligible veteran. The contact information of an appropriate office of the Department for health care providers to confirm that care and services under this section are authorized for the eligible veteran. Contact information and other relevant information for the submittal of claims or bills for the furnishing of care and 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 Choice Card to an eligible veteran, the Secretary shall provide the eligible veteran with information clearly stating the circumstances under which the veteran may be eligible for care and 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: 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 current wait-time goals of the Veterans Health Administration for delivery of such care or services. To be eligible to furnish care and 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, verification of such licenses and credentials maintained by such health care provider. The Secretary shall require an eligible veteran to pay a copayment to the Department for the receipt of care and services under this section only if such eligible veteran would be required to pay such copayment for the receipt of such care and services at a medical facility of the Department. The copayment required under paragraph
(1)shall not be greater than the copayment required of such eligible veteran by the Department for the receipt of such care and services at a medical facility of the Department. 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. Not later than one year after the date of the enactment of this Act, and annually thereafter until the termination date specified in 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 goals for 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 year preceding the submittal of the report. The Secretary shall ensure that any health care provider that furnishes care and services under this section to an eligible veteran submits to the Department any medical record related to the care and 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 and services to such eligible veteran. The Secretary shall implement a mechanism to track any missed appointments for care and services under this section by eligible veterans to ensure that the Department does not pay for such care and 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 540 days after the publication of the interim final regulations under subsection (l), 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 requirement of the Secretary to furnish care and services under this section terminates on the date that is two years after the date on which the Secretary publishes the interim final regulations under subsection (l). Not later than 90 days after the publication of the interim final regulations under subsection (l), 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 and services under this section. A description of the type of care and services furnished to eligible veterans under this section. Not later than 540 days after the publication of the interim final regulations under subsection (l), 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 and services under this section, disaggregated by— eligible veterans described in subsection (b)(2)(A); and eligible veterans described in subsection (b)(2)(B). A description of the type 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 an appointment 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 (n). Nothing in this section shall be construed to require the Secretary to renegotiate contracts for the furnishing of hospital care or medical services to veterans entered into by the Department before the date of the enactment of this Act. Nothing in this section shall be construed to alter the process of the Department for filling and paying for prescription medications.
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Sec. 301
Expanded availability of hospital care and medical services for veterans through the use of contracts
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