Sec. 103. Payment of health care providers under Veterans Choice Program
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Subchapter I of chapter 17 of title 38, United States Code, as amended by section 101(a)(1), is further amended by inserting after section 1703A the following new section: The Secretary shall ensure that payments made to health care providers under the Veterans Choice Program comply with chapter 39 of title 31 (commonly referred to as the Prompt Payment Act ) and the requirements of this section. If there is a conflict between the requirements of the Prompt Payment Act and the requirements of this section, the Secretary shall comply with the requirements of this section.
The Secretary shall reimburse a health care provider for care or services furnished under the Veterans Choice Program— in the case of a clean claim submitted to the Secretary electronically, not later than 30 days after receiving the claim; or in the case of a clean claim submitted to the Secretary in a manner other than electronically, not later than 45 days after receiving the claim. If the Secretary determines that a claim received from a health care provider for care or services furnished under the Veterans Choice Program is a non-clean claim, the Secretary shall submit to the provider, not later than 10 days after receiving the claim— a notification that the claim is a non-clean claim; an explanation of why the claim has been determined to be a non-clean claim; and an identification of the information or documentation that is required to make the claim a clean claim.
If the Secretary does not comply with the requirements of subparagraph
(A)with respect to a claim, the claim shall be deemed a clean claim for purposes of paragraph (1). Upon receipt by the Secretary of information or documentation described in subparagraph (A)(iii) with respect to a claim, the Secretary shall reimburse a health care provider for care or services furnished under the Veterans Choice Program— in the case of a claim submitted to the Secretary electronically, not later than 30 days after receiving such information or documentation; or in the case of claim submitted to the Secretary in a manner other than electronically, not later than 45 days after receiving such information or documentation. If the Secretary fails to comply with the deadlines for payment set forth in this subsection with respect to a claim, interest shall accrue on the amount owed under such claim in accordance with section 3902 of title 31, United States Code. The Secretary shall provide to all health care providers participating in the Veterans Choice Program a list of information and documentation that is required to establish a clean claim under this section. The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1). If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care providers participating in the Veterans Choice Program not later than 30 days before such modifications take effect. On and after January 1, 2019, the Secretary shall not accept any claim under this section that is submitted to the Secretary in a manner other than electronically. In this section: The term clean claim means a claim for reimbursement for care or services furnished under the Veterans Choice Program, on a nationally recognized standard format, that includes the information and documentation necessary to adjudicate the claim. The term non-clean claim means a claim for reimbursement for care or services furnished under the Veterans Choice Program, on a nationally recognized standard format, that does not include the information and documentation necessary to adjudicate the claim. The term Veterans Choice Program means— the program under section 1703A of this title; and the programs, contracts, and agreements of the Department consolidated under section 101(b) of the Veterans Choice Improvement Act of 2016 . . The table of sections at the beginning of chapter 17 of such title, as amended by section 101(a)(2), is further amended by inserting after the item related to section 1703A the following new item: 1703B. Veterans Choice Program: payment of health care providers. . Except as provided in subparagraph (B), on and after January 1, 2019, the Secretary of Veterans Affairs shall not accept any claim for reimbursement under section 1703B of title 38, United States Code, as added by subsection (a), that is submitted to the Secretary in a manner other than electronically, including medical records in connection with such a claim. If the Secretary determines that accepting claims and medical records in a manner other than electronically is necessary for the timely processing of claims for reimbursement under such section 1703B due to a failure or malfunction of the electronic interface established under paragraph (2), the Secretary— may accept claims and medical records in a manner other than electronically for a period not to exceed 90 days; and shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth— the reason for accepting claims and medical records in a manner other than electronically; the duration of time that the Department of Veterans Affairs will accept claims and medical records in a manner other than electronically; and the steps that the Department is taking to resolve such failure or malfunction. Not later than January 1, 2019, the Chief Information Officer of the Department of Veterans Affairs shall establish an electronic interface for health care providers to submit claims for reimbursement under such section 1703B. The electronic interface established under subparagraph
(A)shall include the following functions: A function through which a health care provider may input all relevant data required for claims submittal and reimbursement. A function through which a health care provider may upload medical records to accompany a claim for reimbursement. A function through which a health care provider may ascertain the status of a pending claim for reimbursement that— indicates whether the claim is a clean claim or a non-clean claim; and in the event that a submitted claim is indicated as a non-clean claim, provides— an explanation of why the claim has been determined to be a non-clean claim; and an identification of the information or documentation that is required to make the claim a clean claim. A function through which a health care provider is notified when a claim for reimbursement is accepted or rejected. Such other features as the Secretary considers necessary. The electronic interface established under subparagraph
(A)shall be developed and implemented based on industry-accepted information security and privacy engineering principles and best practices and shall provide for the following: The elicitation, analysis, and prioritization of functional and nonfunctional information security and privacy requirements for such interface, including specific security and privacy services and architectural requirements relating to security and privacy based on a thorough analysis of all reasonably anticipated cyber and noncyber threats to the security and privacy of electronic protected health information made available through such interface. The elicitation, analysis, and prioritization of secure development requirements relating to such interface. The assurance that the prioritized information security and privacy requirements of such interface— are correctly implemented in the design and implementation of such interface throughout the system development lifecycle; and satisfy the information objectives of such interface relating to security and privacy throughout the system development lifecycle. In this subparagraph: The term electronic protected health information has the meaning given that term in section 160.103 of title 45, Code of Federal Regulations, as in effect on the date of the enactment of this Act. The term secure development requirements means, with respect to the electronic interface established under subparagraph (A), activities that are required to be completed during the system development lifecycle of such interface, such as secure coding principles and test methodologies. Not later than January 1, 2017, or before entering into a contract to procure or design and build the electronic interface described in paragraph
(2)or making a decision to internally design and build such electronic interface, whichever occurs first, the Secretary shall— conduct an analysis of commercially available technology that may satisfy the requirements of such electronic interface set forth in such paragraph; and submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth such analysis. The report required under subparagraph (A)(ii) shall include the following: An evaluation of commercially available systems that may satisfy the requirements of paragraph (2). The estimated cost of procuring a commercially available system if a suitable commercially available system exists. If no suitable commercially available system exists, an assessment of the feasibility of modifying a commercially available system to meet the requirements of paragraph (2), including the estimated cost associated with such modifications. If no suitable commercially available system exists and modifying a commercially available system is not feasible, an assessment of the estimated cost and time that would be required to contract with a commercial entity to design and build an electronic interface that meets the requirements of paragraph (2). If the Secretary determines that the Department has the capabilities required to design and build an electronic interface that meets the requirements of paragraph (2), an assessment of the estimated cost and time that would be required to design and build such electronic interface. A description of the decision of the Secretary regarding how the Department plans to establish the electronic interface required under paragraph
(2)and the justification of the Secretary for such decision. The Secretary may not spend any amounts to procure or design and build the electronic interface described in paragraph
(2)until the date that is 60 days after the date on which the Secretary submits the report required under paragraph (3)(A)(iii).