Sec. 4002. PLAN TO CONSOLIDATE PROGRAMS OF DEPARTMENT OF VETERANS AFFAIRS TO IMPROVE ACCESS TO CARE

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## SEC. 4002 PLAN TO CONSOLIDATE PROGRAMS OF DEPARTMENT OF VETERANS AFFAIRS TO IMPROVE ACCESS TO CARE ###

(a)Plan The Secretary of Veterans Affairs shall develop a plan to consolidate all non-Department provider programs by establishing a new, single program to be known as the “Veterans Choice Program” to furnish hospital care and medical services to veterans enrolled in the system of patient enrollment established under section 1705(a) of title 38, United States Code, at non-Department facilities. ###

(b)Elements The plan developed under subsection

(a)to establish the Veterans Choice Program to furnish hospital care and medical services at non-Department facilities shall include, at a minimum, the following: ####

(1)A standardized method to furnish such care and services that incorporates the strengths of the non-Department provider programs into a single streamlined program that the Secretary administers uniformly in each Veterans Service Integrated Network and throughout the medical system of the Veterans Health Administration. ####

(2)An identification of the eligibility requirements for any such care and services, including with respect to service-connected disabilities and non-service-connected disabilities. ####

(3)A description of the authorization process for such care or medical services, including with respect to identifying the roles of clinicians, schedulers, any third-party administrators, the Chief Business Office of the Department, and any other entity involved in the authorization process. ####

(4)The structuring of the billing and reimbursement process, including the use of third-party medical claims adjudicators or technology that supports automatic adjudication. ####

(5)A description of the reimbursement rate to be paid to health care providers under such program. ####

(6)An identification of how the Secretary will determine the eligibility requirements of health care providers at non-Department facilities to participate in such program, including how the Secretary plans to structure a non-Department care network to allow the maximum amount of flexibility in providing care and services under the program. ####

(7)An explanation of the processes to be used to ensure that the Secretary will fully comply with all requirements of chapter 39 of title 31, United States Code (commonly referred to as the “Prompt Payment Act”), in paying for such care and services furnished at non-Department facilities. ####

(8)A description of how, to the greatest extent practicable, the Secretary plans to use infrastructure and networks of non-Department provider programs that exist as of the date of the plan to implement such program. ####

(9)A description of how— #####

(A)health care providers at non-Department facilities that furnish such care or services to veterans under such program will have access to, and transmit back to the Department, the medical records of such veterans; and #####

(B)the Department will receive from such non-Department providers such medical records and any other relevant information. ####

(10)A description of how the Secretary plans to ensure an efficient transition to such program for veterans who participate in the non-Department provider programs, including a timeline, milestones, and estimated costs for implementation, outreach, and training. ###

(c)Submission Not later than November 1, 2015, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report containing— ####

(1)a description of each non-Department provider program and the statutory authority for each such program; ####

(2)the plan under subsection (a); ####

(3)the estimated costs and budgetary requirements to implement the plan and to furnish hospital care and medical services pursuant to such plan; and ####

(4)any recommendations for legislative proposals the Secretary determines necessary to implement such plan. ###

(d)Definitions In this section: ####

(1)The term “non-Department facility” has the meaning given that term in section 1701 of title 38, United States Code. ####

(2)The term “non-Department provider programs” means each program administered by the Secretary of Veterans Affairs under which the Secretary enters into contracts or other agreements with health care providers at non-Department facilities to furnish hospital care and medical services to veterans, including pursuant to the following: #####

(A)Section 1703 of title 38, United States Code. #####

(B)The Veterans Choice Program established by section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note). #####

(C)The Patient Centered Community Care Program (known as “PC3”). #####

(D)The pilot program established by section 403 of the Veterans’ Mental Health and Other Care Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 note) (known as “Project ARCH”). #####

(E)Contracts relating to dialysis. #####

(F)Agreements entered into by the Secretary with— ######

(i)the Secretary of Defense, the Director of the Indian Health Service, or any the head of any other department or agency of the Federal Government; or ######

(ii)any academic affiliate or other non-governmental entity. #####

(G)Programs relating to emergency care, including under sections 1725 and 1728 of title 38, United States Code.

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