Sec. 101. Establishment of Veterans Choice Program

3,062 words·~14 min read·/bill/114/s/2646/is/section-101

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Subchapter I of chapter 17 of title 38, United States Code, is amended by inserting after section 1703 the following new section: Hospital care and medical services under this chapter 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, with entities specified in subparagraph

(B)for the furnishing of such care and services to veterans. The furnishing of hospital care and medical services under this section may be referred to as the Veterans Choice Program . 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. Any health care provider not otherwise covered under any of clauses

(i)through

(iv)that meets criteria established by the Secretary for purposes of this section. 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, 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— 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; 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 physician; 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 does not reside within 20 miles driving distance from a medical facility of the Department described in clause (i); the veteran faces an unusual or excessive burden in accessing hospital care or medical services from a medical facility of the Department that is within 40 miles driving distance from the residence of the veteran due to— geographical challenges; environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather; a medical condition of the veteran that affects the ability to travel; or such other factors as determined by the Secretary; the veteran resides in a location, other than a location in Guam, American Samoa, or the Republic of the Philippines, that requires the veteran to travel by air, boat, or ferry to reach a medical facility of the Department, including a community-based outpatient clinic; 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 Veterans Choice Improvement Act of 2016 ; or 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. In the case of an eligible veteran described in subsection (b)(2)(A), the Secretary shall, at the election of the veteran— provide the veteran an appointment that exceeds the wait-time goals described in such subsection or place such 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; 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 (or other digital channel) 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). Except as provided in subparagraph (B), the Secretary shall enter into contracts for furnishing care and services to eligible veterans under this section with entities specified in subsection (a)(1)(B). Before entering into a contract under this paragraph, the Secretary shall, to the maximum extent practicable and consistent with the requirements of this section, furnish such care and services to such veterans under this section with such entities pursuant to sharing agreements, existing contracts entered into by the Secretary, or other processes available at medical facilities of the Department. A contract entered into under this paragraph may not be treated as a Federal contract for the acquisition of goods or services and is not subject to any provision of law governing Federal contracts for the acquisition of goods or services. In this paragraph, the term contract has the meaning given that term in subpart 2.101 of the Federal Acquisition Regulation. In entering into a contract 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 under 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 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. With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs will be followed, except for when another payment agreement, including a contract or provider agreement, is in place. With respect to care or services furnished under this section in a State with an All-Payer Model Agreement in effect under section 1814 of the Social Security Act ( 42 U.S.C. 1395f ), the Medicare payment rates under clause

(i)shall be calculated based on the payment rates under such agreement. 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 a contract 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). For purposes of receiving care and services under this section, the Secretary shall 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: When the veteran enrolls in the patient enrollment system of the Department established and operated under section 1705 of this title. 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), (D), (E), (F), or

(G)of subsection (b)(2). 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 care or services from that health care provider or another health care provider selected by the veteran, including a health care provider of the Department, through the completion of the episode of care, including all specialty and ancillary services deemed necessary as part of the treatment recommended in the course of such care or 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 annually, 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 under this chapter. 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 under this chapter. The Secretary shall provide for an efficient nationwide system for prompt processing and paying of bills or claims for authorized care and services furnished to eligible veterans under this section. 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 a copy of any medical record related to the care or services provided to such veteran by such health care provider for inclusion in the electronic medical record of such veteran maintained by the Department upon the completion of the provision of such care or services to such veteran. Any medical record submitted to the Department under paragraph

(1)shall, to the extent possible, be in an electronic format. With respect to care or services furnished to an eligible veteran by a health care provider under this section, the receipt by the Department of a medical record under subsection

(k)detailing such care or services is not required before reimbursing the health care provider for such care or services. 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. Nothing in this section shall be construed to alter the process of the Department for filling and paying for prescription medications. Nothing in this section shall be construed to authorize the creation of a tiered network in which an eligible veteran would be required to receive care or services from an entity in a higher tier than any other entity or provider network. 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 180 days after the date of the enactment of the Veterans Choice Improvement Act of 2016 , 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. Section 501 of title 44 shall not apply in carrying out this section. . 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. . Section 101 of the Veterans Access, Choice, and Accountability Act of 2014 ( Public Law 113–146 ; 38 U.S.C. 1701 note) is repealed. Section 208(1) of such Act is amended by striking section 101 and inserting section 1703A of title 38, United States Code . Not later than 180 days after the date of the enactment of this Act, the Secretary of Veterans Affairs 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 section 1703A of title 38, United States Code, as added by paragraph (1), that includes the following: The total number of veterans who have received care or services under this section, disaggregated by— eligible veterans described in subsection (b)(2)(A) of such section; eligible veterans described in subsection (b)(2)(B) of such section; eligible veterans described in subsection (b)(2)(C) of such section; eligible veterans described in subsection (b)(2)(D) of such section; eligible veterans described in subsection (b)(2)(E) of such section; eligible veterans described in subsection (b)(2)(F) of such section; and eligible veterans described in subsection (b)(2)(G) of such section. A description of the types of care and services furnished to veterans under such section. An accounting of the total cost of furnishing care and services to veterans under such section. The results of a survey of veterans who have received care or services under such section on the satisfaction of such veterans with the care or services received by such veterans under such section. An assessment of the effect of furnishing care and services under such section on wait times for appointments for the receipt of hospital care and medical services from the Department of Veterans Affairs. Not later than December 31, 2017, the Secretary of Veterans Affairs shall consolidate the following programs, contracts, and agreements of the Department of Veterans Affairs: The Patient-Centered Community Care program (commonly referred to as PC3 ). Contracts to provide kidney dialysis services. Contracts through the retail pharmacy network of the Department. Veterans Care Agreements under section 1703C of title 38, United States Code, as added by section 201(a). Health care agreements with Federal entities or entities funded by the Federal Government, including the Department of Defense, the Indian Health Service, tribal health programs, Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act ( 42 U.S.C. 1396d(l)(2)(B) )), and academic teaching affiliates. Services provided under the programs, contracts, and agreements consolidated under paragraph

(1)shall be considered services provided under the Veterans Choice Program established under section 1703A of title 38, United States Code, as added by subsection (a)(1). Nothing in this subsection shall be construed to authorize the creation of a tiered network in which an entity or entities would be placed in a higher tier than any other entity or provider network.

Connectionstraces to 7

Traces to 7 documents

U.S. Code