Sec. 272. Authorization of agreements between the Department of Veterans Affairs and non-Department providers

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Subchapter I of chapter 17 of title 38, United States Code, as amended by section 271(a)(1), is further amended by inserting after section 1703A the following new section: In addition to the authority of the Secretary under this chapter to furnish hospital care, medical services, and extended care at facilities of the Department and under contracts or sharing agreements entered into under authorities other than this section, the Secretary may furnish hospital care, medical services, and extended care through the use of agreements entered into under this section.

An agreement entered into under this section may be referred to as a Veterans Care Agreement . The Secretary may enter into agreements under this section with eligible providers that are certified under subsection

(d)if the Secretary is not feasibly able to furnish care or services described in paragraph

(1)at facilities of the Department. The Secretary is not feasibly able to furnish care or services described in paragraph

(1)at facilities of the Department if the Secretary determines that the medical condition of the veteran, the travel involved, the nature of the care or services required, or a combination of those factors make the use of facilities of the Department impracticable or inadvisable. An eligible provider, at its discretion, may opt to enter into an agreement under this section instead of a contract or sharing agreement under authorities other than this section. Eligibility of a veteran under this section for care or services described in subsection (a)(1) shall be determined as if such care or services were furnished in a facility of the Department and provisions of this title applicable to veterans receiving such care or services in a facility of the Department shall apply to veterans receiving such care or services under this section. In carrying out this section, the Secretary— may not direct veterans seeking care or services described in subsection (a)(1) to health care providers that have entered into contracts or sharing agreements under authorities other than this section, except for agreements under section 101 of the Veterans Access, Choice, and Accountability Act of 2014 ( Public Law 113–146 ; 38 U.S.C. 1701 note); and shall ensure that veterans have the option to determine whether to receive such care or services from a health care provider described in subparagraph

(A)or an eligible provider that has entered into an agreement under this section. For purposes of this section, an eligible provider is one of the following: A provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act ( 42 U.S.C. 1395cc(a) ). A physician or supplier that has enrolled and entered into a participation agreement under section 1842(h) of such Act ( 42 U.S.C. 1395u(h) ). A provider of items and services receiving payment under a State plan under title XIX of such Act ( 42 U.S.C. 1396 et seq. ) or a waiver of such a plan. A health care provider that is— an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 ( 42 U.S.C. 3002 )); or a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 ( 29 U.S.C. 796a )). A provider that is located in— an area that is designated as a health professional shortage area (as defined in section 332 of the Public Health Service Act ( 42 U.S.C. 254e )); or a county that is not in a metropolitan statistical area. Such other health care providers as the Secretary considers appropriate for purposes of this section. The Secretary shall establish a process for the certification of eligible providers under this section that shall, at a minimum, set forth the following. Procedures for the submittal of applications for certification and deadlines for actions taken by the Secretary with respect to such applications. Standards and procedures for approval and denial of certification, duration of certification, revocation of certification, and recertification. Procedures for assessing eligible providers based on the risk of fraud, waste, and abuse of such providers similar to the level of screening under section 1866(j)(2)(B) of the Social Security Act ( 42 U.S.C. 1395cc(j)(2)(B) ) and the standards set forth under section 9.104 of title 48, Code of Federal Regulations, or any successor regulation. The Secretary shall deny or revoke certification to an eligible provider under this subsection if the Secretary determines that the eligible provider is currently— excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); or identified as an excluded source on the list maintained in the System for Award Management, or any successor system. Each agreement entered into with an eligible provider under this section shall include provisions requiring the eligible provider to do the following: To accept payment for care or services furnished under this section at rates established by the Secretary for purposes of this section, which shall be, to the extent practicable, the rates paid by the United States for such care or services to providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ). To accept payment under paragraph

(1)as payment in full for care or services furnished under this section and to not seek any payment for such care or services from the recipient of such care or services. To furnish under this section only the care or services authorized by the Department under this section unless the eligible provider receives prior written consent from the Department to furnish care or services outside the scope of such authorization. To bill the Department for care or services furnished under this section in accordance with a methodology established by the Secretary for purposes of this section. Not to seek to recover or collect from a health-plan contract or third party, as those terms are defined in section 1729 of this title, for any care or services for which payment is made by the Department under this section. To provide medical records for veterans furnished care or services under this section to the Department in a time frame and format specified by the Secretary for purposes of this section. To meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify for purposes of this section. An eligible provider may terminate an agreement with the Secretary under this section at such time and upon such notice to the Secretary as the Secretary may specify for purposes of this section. The Secretary may terminate an agreement with an eligible provider under this section at such time and upon such notice to the eligible provider as the Secretary may specify for purposes of this section, if the Secretary— determines that the eligible provider failed to comply substantially with the provisions of the agreement or with the provisions of this section and the regulations prescribed thereunder; determines that the eligible provider is— excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); or identified as an excluded source on the list maintained in the System for Award Management, or any successor system; ascertains that the eligible provider has been convicted of a felony or other serious offense under Federal or State law and determines that the continued participation of the eligible provider would be detrimental to the best interests of veterans or the Department; or determines that it is reasonable to terminate the agreement based on the health care needs of a veteran or veterans. Not less frequently than once every two years, the Secretary shall review each Veterans Care Agreement of material size entered into during the two-year period preceding the review to determine whether it is feasible and advisable to furnish the hospital care, medical services, or extended care furnished under such agreement at facilities of the Department or through contracts or sharing agreements entered into under authorities other than this section. Subject to subparagraph (B), a Veterans Care Agreement is of material size as determined by the Secretary for purposes of this section. A Veterans Care Agreement entered into after September 30, 2016, for the purchase of extended care services is of material size if the purchase of such services under the agreement exceeds $1,000,000 annually. The Secretary may adjust such amount to account for changes in the cost of health care based upon recognized health care market surveys and other available data and shall publish any such adjustments in the Federal Register. An agreement under this section may be entered into without regard to any law that would require the Secretary to use competitive procedures in selecting the party with which to enter into the agreement. Except as provided in subparagraph (B), and unless otherwise provided in this section or section 277 of the Jason Simcakoski Memorial Act or regulations prescribed pursuant to this section or such section 277, an eligible provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which an eligible provider described in subsection (b)(1), (b)(2), or (b)(3) is not subject under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq. ) or the Medicaid program under title XIX of such Act ( 42 U.S.C. 1396 et seq. ). The exclusion under subparagraph

(A)does not apply to laws regarding integrity, ethics, fraud, or that subject a person to civil or criminal penalties. Title VII of the Civil Rights Act of 1964 ( 42 U.S.C. 2000e et seq. ) shall apply with respect to an eligible provider that enters into an agreement under this section to the same extent as such title applies with respect to the eligible provider in providing care or services through an agreement or arrangement other than under this section. The Secretary shall establish a system or systems, consistent with survey and certification procedures used by the Centers for Medicare & Medicaid Services and State survey agencies to the extent practicable— to monitor the quality of care and services furnished to veterans under this section; and to assess the quality of care and services furnished by an eligible provider under this section for purposes of determining whether to renew an agreement under this section with the eligible provider. The Secretary shall establish administrative procedures for eligible providers with which the Secretary has entered into an agreement under this section to present any dispute arising under or related to the agreement. The Secretary may not enter into an agreement under this section, other than for the provision of extended care or hospice care, after September 30, 2017. Nothing in this section shall be construed to alter any contract or agreement entered into between the Department and a State home (as that term is used in subchapter V of this chapter) before the date of the enactment of the Jason Simcakoski Memorial Act . Not later than one year after the date of the enactment of the Jason Simcakoski Memorial Act , and not less frequently than annually thereafter, 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 that contains the following: The total number of agreements entered into with eligible providers under this section. A list of the medical centers of the Department that have entered into agreements with eligible providers under this section. . The Secretary of Veterans Affairs shall prescribe an interim final rule to carry out section 1703B of such title, as added by subsection (a), not later than one year after the date of the enactment of this Act. The table of sections at the beginning of chapter 17 of such title, as amended by section 271(a)(2), is further amended by inserting after the item related to section 1703A the following new item: 1703B. Veterans Care Agreements. .

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