Sec. 101. Improvement of access of veterans to health care through establishment of Veterans Choice Program

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Subchapter I of chapter 17 of title 38, United States Code, is amended by inserting after section 1703 the following new section: The Secretary shall enter into contracts or agreements under sections 1703B, 8111, and 8153 of this title with eligible providers to furnish hospital care and medical services under this chapter to eligible veterans. The provision of hospital care and medical services under this section may be referred to as the Veterans Choice Program . Hospital care and medical services shall be furnished under this section to an eligible veteran at the election of the veteran. An eligible veteran who makes an election under paragraph

(2)to receive hospital care or medical services under this section may select a provider of such care or services from among the health care providers specified in subsection (c)(2) that are accessible to the veteran. The Secretary may not direct an eligible veteran to a provider that is not the eligible provider selected by the veteran under subparagraph (A). A veteran is an eligible veteran for purposes of this section if— the veteran is enrolled in the patient enrollment system of the Department established and operated under section 1705 of this title; and the veteran is unable to schedule an appointment for the receipt of hospital care or medical services from a health care provider of the Department within the lesser of— the wait-time goals of the Veterans Health Administration for such care or services, as determined by the Secretary; or a period determined by a health care provider of the Department to be clinically necessary for the receipt of such care or services; the veteran does not reside within 40 miles driving distance from a medical facility of the Department, including a community-based outpatient clinic, with a full-time primary care provider; the veteran faces an excessive burden in accessing hospital care or medical services from a medical facility of the Department due to— geographical challenges; environmental factors; a medical condition of the veteran that affects the ability to travel; or such other factors as determined by the Secretary; the hospital care or medical services sought by the veteran are not provided at a medical facility of the Department that is accessible to the veteran; the veteran is enrolled in the pilot program under section 403 of the Veterans’ Mental Health and Other Care Improvements Act of 2008 ( Public Law 110–387 ; 38 U.S.C. 1703 note) as of the date of the enactment of the Improving Veterans Access to Care in the Community Act ; the veteran is assigned a primary care provider under section 1705A of this title that is not a health care provider of the Department; and there is a compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care or medical services from a medical facility other than a medical facility of the Department. A health care provider is an eligible provider for purposes of this section if the health care provider is a health care provider specified in paragraph

(2)and meets standards established by the Secretary for purposes of this section, including standards relating to education, certification, licensure, training, and employment history. The health care providers specified in this paragraph 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 health care provider of a 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) )). Any health care provider of the Department of Defense. Any health care provider of the Indian Health Service. Any health care provider of an academic affiliate of the Department of Veterans Affairs. Any health care provider of a health system established to serve Alaska Natives. Any other health care provider that meets criteria established by the Secretary for purposes of this section. To promote the provision of high-quality and high-value health care under this section, the Secretary may develop a tiered provider network of eligible providers based on criteria established by the Secretary for purposes of this section. The Secretary shall be primarily responsible for the payment of costs associated with hospital care and medical services furnished under this section. To the extent practicable, the rates paid by the Secretary for hospital care and medical services furnished under this section— 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; and shall incorporate the use of value-based reimbursement models to promote the provision of high-quality care. An eligible provider that seeks reimbursement for hospital care or medical services furnished under this section shall submit to the Secretary a claim for reimbursement not later than 180 days after furnishing such care or services. Notwithstanding any other provision of law, the Secretary shall reimburse an eligible provider for hospital care or medical services furnished under this section— in the case of a clean claim submitted to the Secretary on paper, not later than 45 calendar days after receiving the claim; or in the case of a clean claim submitted to the Secretary electronically, not later than 30 calendar days after receiving the claim. If the Secretary denies a claim submitted by an eligible provider under paragraph (1), the Secretary shall notify the eligible provider of the reason for denying the claim and the additional information, if any, that may be required to process the claim— in the case of a clean claim submitted to the Secretary on paper, not later than 45 calendar days after receiving the claim; or in the case of a clean claim submitted to the Secretary electronically, not later than 30 calendar days after receiving the claim. Upon receipt by the Secretary of additional information specified under subparagraph

(A)relating to a claim, the Secretary shall pay, deny, or otherwise adjudicate the claim, as appropriate, not later than 30 calendar days after receiving such information. If the Secretary has not reimbursed an eligible provider or denied a claim for reimbursement by the eligible provider under this subsection during the appropriate period specified in this subsection, such claim shall be considered overdue. If a valid claim for reimbursement by an eligible provider is considered overdue under subparagraph (A), in addition to the amount the Secretary owes the eligible provider under the claim, the Secretary shall owe the eligible provider an interest penalty amount that shall— be prorated daily; accrue from the date the payment was overdue; be payable at the time the claim is paid; and be computed at the rate of interest established by the Secretary of the Treasury, and published in the Federal Register, for interest payments under subsections (a)(1) and

(b)of section 7109 of title 41 that is in effect at the time the Secretary accrues the obligation to pay the interest penalty amount. If the Secretary overpays an eligible provider for hospital care or medical services furnished under this section, the Secretary shall deduct the amount of any overpayment from payments due to the eligible provider after the date of such overpayment. Before deducting any amount from a payment to an eligible provider under subparagraph (A), the Secretary shall ensure that the eligible provider is provided an opportunity— to dispute the existence or amount of any overpayment owed to the Department; and to request a compromise with respect to any such overpayment. The Secretary may not make any deduction from a payment to an eligible provider under subparagraph

(A)unless the Secretary has made reasonable efforts to notify the eligible provider of the rights of the eligible provider under subclauses

(I)and

(II)of clause (i). Upon receiving a dispute under subclause

(I)of clause

(i)or a request under subclause

(II)of such clause, the Secretary shall make a determination with respect to such dispute or request before making any deduction under subparagraph

(A)unless the time required to make such a determination would jeopardize the ability of the Secretary to recover the full amount owed to the Department. Notwithstanding any other provision of law— the authority of the Secretary to make deductions under paragraph

(5)or take any other action for the purpose of collecting a debt owed to the United States under this section shall not be subject to any limitation with respect to the time for bringing civil actions or for commencing administrative proceedings; and the Secretary may, except in the case of a fraudulent claim, false claim, or misrepresented claim, compromise any claim of an amount owed to the United States under this section. This subsection shall apply only to payments made on a claims basis and not to capitation or other forms of periodic payments to eligible providers. The Secretary shall require an eligible veteran to pay a copayment for the receipt of hospital care or medical services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services under this chapter at a medical facility of the Department or from a health care provider of the Department. The amount of any copayment charged to an eligible veteran under paragraph

(1)for the receipt of hospital care or medical services under this section may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services under this chapter at a medical facility of the Department or from a health care provider of the Department. The Secretary shall establish such procedures to promote coordination of care and the sharing of health information as the Secretary considers appropriate to carry out this section. The Secretary shall prescribe regulations to carry out this section. The Secretary may not furnish hospital care or medical services under this section before the date specified in section 101(p)(2) of the Veterans Access, Choice, and Accountability Act of 2014 ( Public Law 113–146 ; 38 U.S.C. 1701 note). In this section: The term Alaska Native means a person who is a member of any Native village, Village Corporation, or Regional Corporation, as those terms are defined in section 3 of the Alaska Native Claims Settlement Act ( 43 U.S.C. 1602 ). The term clean claim means a claim submitted— to the Secretary by an eligible provider for purposes of payment by the Secretary of expenses for hospital care or medical services furnished under this section; that contains substantially all of the required elements necessary for accurate adjudication, without requiring additional information from the eligible provider; and in such format as may be prescribed by the Secretary for purposes of paying claims for hospital care or medical services furnished under this section. The term fraudulent claim — means a claim by a health care provider for reimbursement under this section that includes an intentional and deliberate misrepresentation of a material fact or facts that is intended to induce the Secretary to pay an amount that was not legally owed to the provider; and does not include a claim in which a misrepresentation is made in reliance on a good faith interpretation by a health care provider of the utilization, medical necessity, coding, or billing requirements of the Secretary. . The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1703 the following new item: 1703A. Veterans Choice Program. .

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