Sec. 122. Payment rates for community care
407 words·~2 min read·
/bill/115/s/2184/is/section-122A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Subchapter I of chapter 17, as amended by section 121 of this Act, is further amended by inserting after section 1703D the following new section: Except as provided in subsection (b), and to the extent practicable, the rate paid for hospital care or medical services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (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 XI or title XVIII of the Social Security Act ( 42 U.S.C. 1301 et seq. and 1395 et seq.) for the same care or services, including rates adjusted for critical access hospitals under section 1834(g) of such Act ( 42 U.S.C. 1395m(g) ). A higher rate than the rate paid by the United States as described in subsection
(a)may be negotiated with respect to the furnishing of care or services to a veteran described in section 1703(b) of this title who resides in a highly rural area or in a market area where the availability of care or services is limited and a higher rate of pay may be required. In this paragraph, 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. With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract, provider agreement or Veterans Care Agreement, is in place. With respect to furnishing care or services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act ( 42 U.S.C. 1395f(b)(3) ) that became effective on or after January 1, 2014, the Medicare payment rates under subparagraph
(A)shall be calculated based on the payment rates under such agreement. Notwithstanding subsection (a), the Secretary shall incorporate, to the greatest extent practicable, the use of value-based reimbursement models to promote the provision of high quality care. . The table of sections at the beginning of such chapter is amended by inserting after the item relating to section 1703D, as added by section 121 of this Act, the following new item: 1703E. Payment Rates for Community Care. .
Connectionstraces to 4
Citation graph
cites case law
Cites 4Cited by 0 across 0 sources