Sec. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES
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## SEC. 101 EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES ###
(a)Expansion of Available Care and Services ####
(1)Furnishing of care #####
(A)In General Hospital care and medical services under chapter 17 of title 38, United States Code, shall be furnished to an eligible veteran described in subsection (b), at the election of such veteran, through agreements authorized under subsection (d), or any other law administered by the Secretary of Veterans Affairs, with entities specified in subparagraph
(B)for the furnishing of such care and services to veterans. #####
(B)Entities specified The entities specified in this subparagraph are the following: ######
(i)Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.), including any physician furnishing services under such program. ######
(ii)Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (42 U.S.C. 1396d(l)(2)(B))). ######
(iii)The Department of Defense. ######
(iv)The Indian Health Service. ######
(v)Subject to subsection (d)(5), a health care provider not otherwise covered under any of clauses
(i)through (iv). ####
(2)Choice of provider An eligible veteran who makes an election under subsection
(c)to receive hospital care or medical services under this section may select a provider of such care or services from among the entities specified in paragraph (1)(B) that are accessible to the veteran. ####
(3)Coordination of care and services The Secretary shall coordinate, through the Non-VA Care Coordination Program of the Department of Veterans Affairs, the furnishing of care and services under this section to eligible veterans, including by ensuring that an eligible veteran receives an appointment for such care and services within the wait-time goals of the Veterans Health Administration for the furnishing of hospital care and medical services. ###
(b)Eligible Veterans A veteran is an eligible veteran for purposes of this section if— ####
(1)the veteran is enrolled in the patient enrollment system of the Department of Veterans Affairs established and operated under section 1705 of title 38, United States Code, including any such veteran who has not received hospital care or medical services from the Department and has contacted the Department seeking an initial appointment from the Department for the receipt of such care or services; and ####
(2)the veteran— #####
(A)attempts, or has attempted, to schedule an appointment for the receipt of hospital care or medical services under chapter 17 of title 38, United States Code, but is unable to schedule an appointment within— ######
(i)the wait-time goals of the Veterans Health Administration for the furnishing of such care or services; or ######
(ii)with respect to such care or services that are clinically necessary, the period determined necessary for such care or services if such period is shorter than such wait-time goals; #####
(B)resides more than 40 miles (as calculated based on distance traveled) from— ######
(i)with respect to a veteran who is seeking primary care, a medical facility of the Department, including a community-based outpatient clinic, that is able to provide such primary care by a full-time primary care physician; or ######
(ii)with respect to a veteran not covered under clause (i), the medical facility of the Department, including a community-based outpatient clinic, that is closest to the residence of the veteran; #####
(C)resides— ######
(i)in a State without a medical facility of the Department that provides— ######
(I)hospital care; ######
(II)emergency medical services; and ######
(III)surgical care rated by the Secretary as having a surgical complexity of standard; and ######
(ii)more than 20 miles from a medical facility of the Department described in clause (i); or #####
(D)######
(i)resides in a location, other than a location in Guam, American Samoa, or the Republic of the Philippines, that is 40 miles or less from a medical facility of the Department, including a community-based outpatient clinic; and ######
(ii)######
(I)is required to travel by air, boat, or ferry to reach each medical facility described in clause
(i)that is 40 miles or less from the residence of the veteran; or ###### (II)1 faces an unusual or excessive burden in traveling to such a medical facility of the Department based on— ######
(aa)geographical challenges; ######
(bb)environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather; ######
(cc)a medical condition that impacts the ability to travel; or ######
(dd)other factors, as determined by the Secretary. 1Margin for subclause
(II)so in law. ###
(c)Election and Authorization ####
(1)In general In the case of an eligible veteran described in subsection (b)(2)(A), the Secretary shall, at the election of the eligible veteran— #####
(A)provide the veteran an appointment that exceeds the wait-time goals described in such subsection or place such eligible veteran on an electronic waiting list described in paragraph
(2)for an appointment for hospital care or medical services the veteran has elected to receive under this section; or #####
(B)######
(i)authorize that such care or services be furnished to the eligible veteran under this section for a period of time specified by the Secretary; and ######
(ii)notify the eligible veteran by the most effective means available, including electronic communication or notification in writing, describing the care or services the eligible veteran is eligible to receive under this section. ####
(2)Electronic waiting list The electronic waiting list described in this paragraph shall be maintained by the Department and allow access by each eligible veteran via www.myhealth.va.gov or any successor website (or other digital channel) for the following purposes: #####
(A)To determine the place of such eligible veteran on the waiting list. #####
(B)To determine the average length of time an individual spends on the waiting list, disaggregated by medical facility of the Department and type of care or service needed, for purposes of allowing such eligible veteran to make an informed election under paragraph (1). ###
(d)Care and Services Through Agreements ####
(1)Agreements #####
(A)In general The Secretary shall enter into agreements for furnishing care and services to eligible veterans under this section with entities specified in subsection (a)(1)(B). An agreement entered into pursuant to this subparagraph may not be treated as a Federal contract for the acquisition of goods or services and is not subject to any provision of law governing Federal contracts for the acquisition of goods or services. Before entering into an agreement pursuant to this subparagraph, the Secretary shall, to the maximum extent practicable and consistent with the requirements of this section, furnish such care and services to such veterans under this section with such entities pursuant to sharing agreements, existing contracts entered into by the Secretary, or other processes available at medical facilities of the Department. #####
(B)Agreement defined In this paragraph, the term “agreement” includes contracts, intergovernmental agreements, and provider agreements, as appropriate. ####
(2)Rates and reimbursement #####
(A)In general In entering into an agreement under paragraph
(1)with an entity specified in subsection (a)(1)(B), the Secretary shall— ######
(i)negotiate rates for the furnishing of care and services under this section; and ######
(ii)reimburse the entity for such care and services at the rates negotiated pursuant to clause
(i)as provided in such agreement. #####
(B)Limit on rates ######
(i)In general Except as provided in clause (ii), rates negotiated under subparagraph (A)(i) shall not be more than the rates paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (42 U.S.C. 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 XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) for the same care or services. ######
(ii)Exception ######
(I)In general The Secretary may negotiate a rate that is more than the rate paid by the United States as described in clause
(i)with respect to the furnishing of care or services under this section to an eligible veteran who resides in a highly rural area. ######
(II)Highly rural area defined In this clause, 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. ######
(III)Other exceptions With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs will be followed, except for when another payment agreement, including a contract or provider agreement, is in place. With respect to care or services furnished under this section in a State with an All-Payer Model Agreement under the Social Security Act that became effective on January 1, 2014, the Medicare payment rates under clause
(i)shall be calculated based on the payment rates under such agreement. #####
(C)Limit on collection For the furnishing of care or services pursuant to an agreement under paragraph (1), an entity specified in subsection (a)(1)(B) may not collect any amount that is greater than the rate negotiated pursuant to subparagraph (A)(i). ####
(3)Certain procedures #####
(A)In general In entering into an agreement under paragraph
(1)with an entity described in subparagraph (B), the Secretary may use the procedures, including those procedures relating to reimbursement, available for entering into provider agreements under section 1866(a) of the Social Security Act (42 U.S.C. 1395cc(a)) and participation agreements under section 1842(h) of such Act (42 U.S.C. 1395u(h)). During the period in which such entity furnishes care or services pursuant to this section, such entity may not be treated as a Federal contractor or subcontractor by the Office of Federal Contract Compliance Programs of the Department of Labor by virtue of furnishing such care or services. #####
(B)Entities described The entities described in this subparagraph are the following: ######
(i)In the case of the Medicare program, any provider of services that has 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 entered into a participation agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h)); and ######
(ii)In the case of the Medicaid program, any provider participating under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.). ####
(4)Information on policies and procedures The Secretary shall provide to any entity with which the Secretary has entered into an agreement under paragraph
(1)the following: #####
(A)Information on applicable policies and procedures for submitting bills or claims for authorized care or services furnished to eligible veterans under this section. #####
(B)Access to a telephone hotline maintained by the Department that such entity may call for information on the following: ######
(i)Procedures for furnishing care and services under this section. ######
(ii)Procedures for submitting bills or claims for authorized care and services furnished to eligible veterans under this section and being reimbursed for furnishing such care and services. ######
(iii)Whether particular care or services under this section are authorized, and the procedures for authorization of such care or services. ####
(5)Agreements with other providers In accordance with the rates determined pursuant to paragraph (2), the Secretary may enter into agreements under paragraph
(1)for furnishing care and services to eligible veterans under this section with an entity specified in subsection (a)(1)(B)(v) if the entity meets criteria established by the Secretary for purposes of this section. ###
(e)Responsibility for Costs of Certain Care ####
(1)Submittal of information on health-care plans Before receiving hospital care or medical services under this section, an eligible veteran shall provide to the Secretary information on any health-care plan described in paragraph
(2)under which the eligible veteran is covered. ####
(2)Health-care plan A health-care plan described in this paragraph— #####
(A)is an insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar arrangement not administered by the Secretary of Veterans Affairs, under which health services for individuals are provided or the expenses of such services are paid; and #####
(B)does not include any such policy, contract, agreement, or similar arrangement pursuant to title XVIII or XIX of the Social Security Act (42 U.S.C. 1395 et seq.) or chapter 55 of title 10, United States Code. ####
(3)Recovery of costs for certain care #####
(A)In general In any case in which an eligible veteran is furnished hospital care or medical services under this section for a non-service-connected disability described in subsection (a)(2) of section 1729 of title 38, United States Code, or for a condition for which recovery is authorized or with respect to which the United States is deemed to be a third party beneficiary under Public Law 87–693, commonly known as the “Federal Medical Care Recovery Act” (42 U.S.C. 2651 et seq.), the Secretary shall recover or collect from a third party (as defined in subsection
(i)of such section 1729) reasonable charges for such care or services to the extent that the veteran (or the provider of the care or services) would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished by a department or agency of the United States. #####
(B)Use of amounts Amounts collected by the Secretary under subparagraph
(A)shall be deposited in the Medical Community Care account of the Department. Amounts so deposited shall remain available until expended. ###
(f)Veterans Choice Card ####
(1)In general For purposes of receiving care and services under this section, the Secretary shall, not later than 90 days after the date of the enactment of this Act, issue to each veteran described in subsection (b)(1) a card that may be presented to a health care provider to facilitate the receipt of care or services under this section. ####
(2)Name of card Each card issued under paragraph
(1)shall be known as a “Veterans Choice Card”. ####
(3)Details of card Each Veterans Choice Card issued to a veteran under paragraph
(1)shall include the following: #####
(A)The name of the veteran. #####
(B)An identification number for the veteran that is not the social security number of the veteran. #####
(C)The contact information of an appropriate office of the Department for health care providers to confirm that care or services under this section are authorized for the veteran. #####
(D)Contact information and other relevant information for the submittal of claims or bills for the furnishing of care or services under this section. #####
(E)The following statement: “This card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone number specified on this card to ensure that treatment has been authorized.”. ####
(4)Information on use of card Upon issuing a Veterans Choice Card to a veteran, the Secretary shall provide the veteran with information clearly stating the circumstances under which the veteran may be eligible for care or services under this section. ###
(g)Information on Availability of Care The Secretary shall provide information to a veteran about the availability of care and services under this section in the following circumstances: ####
(1)When the veteran enrolls in the patient enrollment system of the Department under section 1705 of title 38, United States Code. ####
(2)When the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the Department but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services. ####
(3)When the veteran becomes eligible for hospital care or medical services under this section under subparagraph (B), (C), or
(D)of subsection (b)(2). ###
(h)Follow-Up Care In carrying out this section, the Secretary shall ensure that, at the election of an eligible veteran who receives hospital care or medical services from a health care provider in an episode of care under this section, the veteran receives such hospital care and medical services from such health care provider through the completion of the episode of care, including all specialty and ancillary services deemed necessary as part of the treatment recommended in the course of such hospital care or medical services. ###
(i)Providers To be eligible to furnish care or services under this section, a health care provider must— ####
(1)maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the Department, as determined by the Secretary for purposes of this section; and ####
(2)submit, not less frequently than once each year during the period in which the Secretary is authorized to carry out this section pursuant to subsection (p), verification of such licenses and credentials maintained by such health care provider. ###
(j)Cost-Sharing ####
(1)In general The Secretary shall require an eligible veteran to pay a copayment for the receipt of care or services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department pursuant to chapter 17 of title 38, United States Code. ####
(2)Limitation The amount of a copayment charged under paragraph
(1)may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department pursuant to chapter 17 of title 38, United States Code. ####
(3)Collection of copayment A health care provider that furnishes care or services to an eligible veteran under this section shall collect the copayment required under paragraph
(1)from such eligible veteran at the time of furnishing such care or services. ###
(k)Claims processing system ####
(1)In general The Secretary shall provide for an efficient nationwide system for processing and paying bills or claims for authorized care and services furnished to eligible veterans under this section. ####
(2)Regulations Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall prescribe regulations for the implementation of such system. ####
(3)Oversight The Chief Business Office of the Veterans Health Administration shall oversee the implementation and maintenance of such system. ####
(4)Accuracy of payment #####
(A)In general The Secretary shall ensure that such system meets such goals for accuracy of payment as the Secretary shall specify for purposes of this section. #####
(B)Quarterly report ######
(i)In general 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 quarterly report on the accuracy of such system. ######
(ii)Elements Each report required by clause
(i)shall include the following: ######
(I)A description of the goals for accuracy for such system specified by the Secretary under subparagraph (A). ######
(II)An assessment of the success of the Department in meeting such goals during the quarter covered by the report. ######
(iii)Deadline The Secretary shall submit each report required by clause
(i)not later than 20 days after the end of the quarter covered by the report. ###
(l)Medical Records ####
(1)In general The Secretary shall ensure that any health care provider that furnishes care or services under this section to an eligible veteran submits to the Department a copy of any medical record related to the care or services provided to such eligible veteran by such health care provider for inclusion in the electronic medical record of such eligible veteran maintained by the Department upon the completion of the provision of such care or services to such eligible veteran. ####
(2)Electronic format Any medical record submitted to the Department under paragraph
(1)shall, to the extent possible, be in an electronic format. ###
(m)Tracking of Missed Appointments The Secretary shall implement a mechanism to track any missed appointments for care or services under this section by eligible veterans to ensure that the Department does not pay for such care or services that were not furnished to an eligible veteran. ###
(n)Implementation Not later than 90 days after the date of the enactment of this Act, the Secretary shall prescribe interim final regulations on the implementation of this section and publish such regulations in the Federal Register. ###
(o)Inspector General Report Not later than 30 days after the date on which the Secretary determines that 75 percent of the amounts deposited in the Veterans Choice Fund established by section 802 have been exhausted, the Inspector General of the Department shall submit to the Secretary a report on the results of an audit of the care and services furnished under this section to ensure the accuracy and timeliness of payments by the Department for the cost of such care and services, including any findings and recommendations of the Inspector General. ###
(p)Authority to Furnish Care and Services The Secretary may not use the authority under this section to furnish care and services after the date that is 1 year after the date of the enactment of the Caring for Our Veterans Act of 2018. ###
(q)Reports ####
(1)Initial report Not later than 90 days after the publication of the interim final regulations under subsection (n), 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 on the furnishing of care and services under this section that includes the following: #####
(A)The number of eligible veterans who have received care or services under this section. #####
(B)A description of the types of care and services furnished to eligible veterans under this section. ####
(2)Final report Not later than 30 days after the date on which the Secretary determines that 75 percent of the amounts deposited in the Veterans Choice Fund established by section 802 have been exhausted, 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 on the furnishing of care and services under this section that includes the following: #####
(A)The total number of eligible veterans who have received care or services under this section, disaggregated by— ######
(i)eligible veterans described in subsection (b)(2)(A); ######
(ii)eligible veterans described in subsection (b)(2)(B); ######
(iii)eligible veterans described in subsection (b)(2)(C); and ######
(iv)eligible veterans described in subsection (b)(2)(D). #####
(B)A description of the types of care and services furnished to eligible veterans under this section. #####
(C)An accounting of the total cost of furnishing care and services to eligible veterans under this section. #####
(D)The results of a survey of eligible veterans who have received care or services under this section on the satisfaction of such eligible veterans with the care or services received by such eligible veterans under this section. #####
(E)An assessment of the effect of furnishing care and services under this section on wait times for appointments for the receipt of hospital care and medical services from the Department. #####
(F)An assessment of the feasibility and advisability of continuing furnishing care and services under this section after the termination date specified in subsection (p). ###
(r)Rule of Construction Nothing in this section shall be construed to alter the process of the Department for filling and paying for prescription medications. ###
(s)Wait-Time Goals of the Veterans Health Administration ####
(1)In general Except as provided in paragraph (2), in this section, the term “wait-time goals of the Veterans Health Administration” means not more than 30 days from the date on which a veteran requests an appointment for hospital care or medical services from the Department. ####
(2)Alternate goals If the Secretary submits to Congress, not later than 60 days after the date of the enactment of this Act, a report stating that the actual wait-time goals of the Veterans Health Administration are different from the wait-time goals specified in paragraph (1)— #####
(A)for purposes of this section, the wait-time goals of the Veterans Health Administration shall be the wait-time goals submitted by the Secretary under this paragraph; and #####
(B)the Secretary shall publish such wait-time goals in the Federal Register and on an Internet website of the Department available to the public. ###
(t)Waiver of Certain Printing Requirements Section 501 of title 44, United States Code, shall not apply in carrying out this section.
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- Pub. L. 87-693
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Sec. 101
EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES
Pub. L.Pub. L. 87-693
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