Sec. 112. Authorization of agreements between Department of Veterans Affairs and non-Department providers
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Subchapter I of chapter 17, as amended by sections 101 and 103, is further amended by inserting after section 1703 the following new section: When hospital care, a medical service, or an extended care service is not available to a veteran described in section 1703(b) of this title from a medical facility of the Department or through a contract or sharing agreement entered into under this title under an authority other than this section, the Secretary may furnish such care or service to such veteran to avoid a delay or lapse in such care or service by entering into an agreement under this section with a health care provider specified in section 1703(c) of this title to provide such care or service.
An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a Veterans Care Agreement . For purposes of subparagraph (A), hospital care, a medical service, or an extended care service may be considered not available to a veteran from a medical facility of the Department or through a contract or sharing agreement described in such subparagraph when the Secretary determines the veteran's medical condition, the travel involved, the nature of the care or services required, or a combination of these factors make the use of a facility of the Department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable.
A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary. Subject to subparagraph (B), the Secretary shall review each Veterans Care Agreement of material size, as determined by the Secretary or set forth in paragraph (3), for hospital care, a medical service, or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the Department or by contract or sharing agreement entered into pursuant to another provision of law and, if so, take action to do so.
The Secretary shall review each Veterans Care Agreement of material size that has been in effect for at least six months within the first two years of its taking effect, and no less frequently than once every four years thereafter. If a Veterans Care Agreement has not been in effect for at least six months by the date of the review required by subparagraph (A), the agreement will be reviewed during the next cycle required by subparagraph (A), and such review will serve as its review within the first two years of its taking effect for purposes of clause (i).
In addition to such other Veterans Care Agreements as the Secretary may determine are of material size, each Veterans Care Agreement that takes effect after the date of the enactment of the Veterans Community Care and Access Act of 2017 shall be considered of material size. The Secretary, and any other Department official authorized by the Secretary, may enter into an agreement under this section for extended care services only if the Secretary does not expect such agreement would result in an obligation of the Department that exceeds a rate of $5,000,000 annually.
If the Secretary enters into an agreement with a provider under this section and pursuant to the agreement the Department incurs an obligation that exceeds an annual rate of, with respect to extended care services, the rate set forth in subparagraph (A), and with respect to services that are not extended care services, $2,000,000, the Secretary shall submit to the appropriate committees of Congress notice that such obligation has exceeded such rate and an accounting of the cost and need for such agreement if such provider is unable or unwilling to enter into a contract or other agreement under section 1703 of this title.
In this paragraph, the term appropriate committees of Congress means— the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives. For purposes of this section, an eligible entity or provider is— any 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) ) and any physician or other supplier who has enrolled and entered into a participation agreement under section 1842(h) of such Act ( 42 U.S.C. 1395u(h) ); any provider participating under a State plan under title XIX of such Act ( 42 U.S.C. 1396 et seq.); or any entity or provider not described in paragraph
(1)or
(2)of this subsection that the Secretary determines to be eligible pursuant to the certification process described in subsection (c). The Secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section. Such a process shall, at a minimum— establish deadlines for actions on applications for certification; set forth standards for an approval or denial of certification, duration of certification, revocation of an eligible entity or provider’s certification, and recertification of eligible entities or providers; require the denial of certification if the Secretary determines the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7 or 1320a–7a) or is currently identified as an excluded source on the System for Award Management Exclusions list described in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations; establish procedures for screening eligible entities or providers according to the risk of fraud, waste, and abuse that are similar to the standards under section 1866(j)(2)(B) of the Social Security Act ( 42 U.S.C. 1395cc(j)(2)(B) ) and section 9.104 and subpart 9.4 of title 48, Code of Federal Regulations, or successor regulations; and incorporate and apply the restrictions and penalties set forth in chapter 21 of title 41 and treat this section as a procurement program only for purposes of applying such provisions. To the extent practicable, the rates paid by the Secretary for hospital care, medical services, and extended care services provided under a Veterans Care Agreement shall be in accordance with the rates paid by the United States under the Medicare program. Pursuant to regulations promulgated under subsection (k), the Secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services, the number of employees employed by the entity or provider furnishing such care or services, the amount paid by the Secretary to the provider or entity, or other factors as determined by the Secretary. To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree— to accept payment at the rates established in regulations prescribed under this section; that payment by the Secretary under this section on behalf of a veteran to a provider of services or care shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguish any liability on the part of the veteran for the treatment or care provided, and no provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement; to provide only the care and services authorized by the Department under this section and to obtain the prior written consent of the Department to furnish care or services outside the scope of such authorization; to bill the Department in accordance with the methodology outlined in regulations prescribed under this section; to not 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 service for which payment is made by the Department; to provide medical records to the Department in the time frame and format specified by the Department; and to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation. An eligible entity or provider may discontinue a Veterans Care Agreement at such time and upon such notice to the Secretary as may be provided in regulations prescribed under this section. The Secretary may discontinue a Veterans Care Agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section, if an official designated by the Secretary— has determined that the eligible entity or provider failed to comply substantially with the provisions of the Veterans Care Agreement, or with the provisions of this section or regulations prescribed under this section; has determined the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act ( 42 U.S.C. 1320a–7 or 1320a–7a) or is identified on the System for Award Management Exclusions list as provided in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations; has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under Federal or State law and determines the eligible entity or provider’s continued participation would be detrimental to the best interests of veterans or the Department; or has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran. The standards for quality established under section 1703C of this title shall be applied in monitoring the quality of care provided to veterans through Veterans Care Agreements and for assessing the quality of hospital care, medical services, and extended care services furnished by eligible entities and providers before the renewal of Veterans Care Agreements. The Secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements. Such procedures constitute the eligible entities’ and providers’ exhaustive and exclusive administrative remedies. Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section 1346 of title 28 (known as the Tucker Act ). Disputes under this section must pertain to either the scope of authorization under the Veterans Care Agreement or claims for payment subject to the Veterans Care Agreement and are not claims for the purposes of such laws that would otherwise require application of sections 7101 through 7109 of title 41, United States Code. A Veterans Care Agreement may be authorized by the Secretary or any Department official authorized by the Secretary, and such action is not an award for the purposes of such laws that would otherwise require the use of competitive procedures for furnishing of care and services. Except as provided in subparagraph (B), and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible entity or provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.) are not subject. An eligible entity or provider that enters into an agreement under this section is subject to— all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities. Eligibility for hospital care, medical services, and extended care services furnished to any veteran pursuant to a Veterans Care Agreement shall be subject to the same terms as though provided in a facility of the Department, and provisions of this chapter applicable to veterans receiving such care and services in a facility of the Department shall apply to veterans treated under this section. The Secretary shall promulgate regulations to carry out this section. . The table of sections at the beginning of such chapter is amended by inserting after the item related to section 1703 the following new item: 1703A. Agreements with eligible entities or providers; certification processes. .
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- 42 USC 1320a–7
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Sec. 112
Authorization of agreements between Department of Veterans Affairs and non-Department providers
Cite42 USC 1320a–7
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