Sec. 103. Veterans Care Agreements

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Subchapter I of chapter 17 of title 38, United States Code, is further amended by inserting after section 1703A, as added by section 102, the following new section: In addition to furnishing hospital care, medical services, or extended care services under this chapter at facilities of the Department or under contracts or agreements entered into pursuant to section 1703A of this title or any other provision of law other than this section, the Secretary may furnish such care and services to eligible veterans through the use of agreements, to be known as Veterans Care Agreements , entered into under this section by the Secretary with eligible non-network providers.

The Secretary may enter into a Veterans Care Agreement under this section with an eligible non-network provider if the Secretary determines that— the provision of the hospital care, medical services, or extended care services at a Department facility is impracticable or inadvisable because of the medical condition of the veteran, the travel involved, or the nature of the care or services required, or a combination of such factors; and such care or services are not available to be furnished by a non-Department health care provider under a contract or agreement entered into pursuant to a provision of law other than this section.

In accordance with subparagraphs

(C)and (D), the Secretary shall review each Veterans Care Agreement with a non-network provider to determine whether it is practical or advisable to, instead of carrying out such agreement— provide at a Department facility the hospital care, medical services, or extended care services covered by such agreement; or enter into an agreement with the provider under section 1703A of this title to provide such care or services. If the Secretary determines pursuant to a review of a Veterans Care Agreement under subparagraph

(A)that it is practical or advisable to provide hospital care, medical services, or extended care services at a Department facility, or enter into an agreement under section 1703A of this title to provide such care or services, as the case may be, the Secretary— may not renew the Veterans Care Agreement; and shall take such actions as are necessary to implement such determination. This paragraph shall apply with respect to Veterans Care Agreements entered into with a non-network provider whose gross annual revenue, as determined under subsection (b)(1), exceeds— $3,000,000, in the case of a provider that furnishes homemaker or home health aide services; or $1,000,000, in the case of any other provider. The Secretary shall conduct each review of a Veterans Care Agreement under subparagraph

(A)as follows: Once during the 18-month period beginning on the date that is six months after date on which the agreement is entered into. Not less than once during each four-year period beginning on the date on which the review under subparagraph

(A)is conducted. A provider of hospital care, medical services, or extended care services is eligible to enter into a Veterans Care Agreement under this section if the Secretary determines that the provider meets the following criteria: The gross annual revenue of the provider under contracts or agreements entered into with the Secretary in the year preceding the year in which the provider enters into the Veterans Care Agreement does not exceed— $5,000,000 (as adjusted in a manner similar to amounts adjusted pursuant to section 5312 of this title), in the case of a provider that furnishes homemaker or home health aide services; or $2,000,000 (as so adjusted), in the case of any other provider. The provider is not a network provider and does not otherwise provide hospital care, medical services, or extended care services to patients pursuant to a contract entered into with the Department. The provider is— 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; 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 )). The provider is certified pursuant to the process established under subsection (c)(1). Any additional criteria determined appropriate by the Secretary. The Secretary shall establish a process for the certification of eligible providers to enter into Veterans Care Agreements under this section that shall, at a minimum, set forth the following: Procedures for the submission of applications for certification and deadlines for actions taken by the Secretary with respect to such applications. Standards and procedures for the approval and denial of certifications and the revocation of certifications. 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. 1395(j)(2)(B) ) and the standards set forth under section 9.104 of title 48, Code of Federal Regulations, or any successor regulation. Requirement for denial or revocation of certification if the Secretary determines that the otherwise 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. Procedures by which a provider whose certification is denied or revoked under the procedures established under this subsection will be identified as an excluded source on the list maintained in the System for Award Management, or successor system, if the Secretary determines that such exclusion is appropriate. To the extent practicable, the Secretary shall establish the procedures under paragraph

(1)in a manner that takes into account any certification process administered by another department or agency of the Federal Government that an eligible provider has completed by reason of being a provider described in any of subparagraphs

(A)through

(E)of subsection (b)(4). The Secretary shall— verify upon enrollment, and annually thereafter, that eligible providers have not been excluded from participation in other federally funded health care programs; and submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate an annual report on the results of such verifications. Subsections (d), (e), (f), and

(g)of section 1703A of this title shall apply with respect to a Veterans Care Agreement in the same manner such subsections apply to contracts and agreements entered into under such section. Notwithstanding any other provision of law, the Secretary may enter into a Veterans Care Agreement using procedures other than competitive procedures. Except as provided in subparagraph

(B)and unless otherwise provided in this section, an eligible non-network provider that enters into a Veterans Care Agreement under this section is not subject to, in the carrying out of the agreement, any provision of law that providers of services and suppliers 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.) are not subject to. In addition to the provisions of laws covered by subparagraph (A), an eligible non-network provider shall be subject to the following provisions of law: Any applicable law regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties. Section 1352 of title 31, except for the filing requirements under subsection

(b)of such section. Section 4705 or 4712 of title 41, and any other applicable law regarding the protection of whistleblowers. Section 4706(d) of title 41. Title VII of the Civil Rights Act of 1964 ( 42 U.S.C. 2000e et seq.) to the same extent as such title applies with respect to the eligible non-network provider in providing care or services through an agreement or arrangement other than under a Veterans Care Agreement. An eligible non-network provider may terminate a Veterans Care 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 a Veterans Care Agreement with an eligible non-network provider under this section at such time and upon such notice to the provider as the Secretary may specify for the purposes of this section, if the Secretary determines necessary. The Secretary shall establish administrative procedures for providers with which the Secretary has entered into a Veterans Care Agreement to present any dispute arising under or related to the agreement. Before using any dispute resolution mechanism under chapter 71 of title 41 with respect to a dispute arising under a Veterans Care Agreement under this section, a provider must first exhaust the administrative procedures established by the Secretary under paragraph (1). If, in the course of an episode of care for which hospital care, medical services, or extended care services are furnished to an eligible veteran pursuant to a Veterans Care Agreement, any part of such care or services is furnished by a medical provider who is not an eligible non-network provider or a network provider, the Secretary may compensate such provider for furnishing such care or services. The Secretary shall make reasonable efforts to enter into a Veterans Care Agreement with any provider who is compensated pursuant to paragraph (1). Not later than December 31 of the year following the fiscal year in which the Secretary first enters into a Veterans Care Agreement under this section, and each year thereafter, the Secretary shall submit to the appropriate congressional committees an annual report that includes a list of all Veterans Care Agreements entered into as of the date of the report. The requirement to submit a report under paragraph

(1)shall terminate on the date that is five years after the date of the enactment of this section. In carrying out this section, the Secretary shall use the quality of care standards set forth or used by the Centers for Medicare & Medicaid Services or other quality of care standards, as determined by the Secretary. The Secretary may delegate the authority to enter into or terminate a Veterans Care Agreement to an official of the Department at a level not below the Director of a Veterans Integrated Service Network or the Director of a Network Contracting Office. In this section: The term appropriate congressional committees means— the Committees on Veterans’ Affairs of the House of Representatives and the Senate; and the Committees on Appropriations of the House of Representatives and the Senate. The term eligible veteran has the meaning given such term in section 1703A(m) of this title. . The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1703A, as added by section 102, the following new item: 1703B. Veterans Care Agreements with non-network providers. .

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