Veterans Community Care and Access Act of 2017
This bill revises requirements governing health care benefits provided to veterans under programs of the Department of Veterans Affairs (VA), including to: (1) replace the existing VA programs that provide hospital care, medical services, and extended care services to veterans in their communities at non-VA facilities or through non-VA providers with a new Veterans Community Care Program; and (2) provide funds for veterans health care.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 2184 Introduced in Senate (IS)]
<DOC>
115th CONGRESS
1st Session
S. 2184
To amend title 38, United States Code, to improve veterans' health care
benefits, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
December 1, 2017
Mr. McCain (for himself and Mr. Moran) introduced the following bill;
which was read twice and referred to the Committee on Veterans' Affairs
_______________________________________________________________________
A BILL
To amend title 38, United States Code, to improve veterans' health care
benefits, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Veterans Community
Care and Access Act of 2017''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. References to title 38, United States Code.
TITLE I--DEVELOPING AN INTEGRATED HIGH-PERFORMING NETWORK
Subtitle A--Establishing the Veterans Community Care Program
Sec. 101. Establishment of Veterans Community Care Program.
Sec. 102. Strategy regarding the High Performing Integrated Healthcare
Network of the Department.
Sec. 103. Access standards and standards for quality.
Subtitle B--Forming Partnerships and Agreements
Sec. 111. Continuity of care and existing agreements.
Sec. 112. Authorization of agreements between Department of Veterans
Affairs and non-Department providers.
Sec. 113. Prevention of certain health care providers from providing
non-Department health care services to
veterans.
Sec. 114. Conforming amendments for State veterans homes.
Subtitle C--Paying Providers
Sec. 121. Prompt payment to providers.
Sec. 122. Payment rates for community care.
Sec. 123. Authority to pay for authorized care not subject to an
agreement.
TITLE II--STREAMLINING COMMUNITY CARE PROGRAMS
Subtitle A--Streamlining Community Care Programs
Sec. 201. Access to walk-in care.
Sec. 202. Veterans Choice Fund flexibility.
Sec. 203. Conforming amendments.
Subtitle B--Improving Information Sharing With Providers
Sec. 211. Improving information sharing with community providers.
Sec. 212. Establishment of processes to ensure safe opioid prescribing
practices by non-Department of Veterans
Affairs health care providers.
Subtitle C--Improving Collections
Sec. 221. Aligning with best practices on collection of health
insurance information.
Sec. 222. Improving authority to collect.
TITLE III--IMPROVING DEPARTMENT OF VETERANS AFFAIRS CARE DELIVERY
Subtitle A--Improving Personnel Practices
Sec. 301. Licensure of health care professionals of the Department of
Veterans Affairs providing treatment via
telemedicine.
Sec. 302. Graduate medical education and residency.
Sec. 303. Annual report on awards or bonuses awarded to certain high-
level employees of the department of
veterans affairs.
Subtitle B--Facilities, Construction, and Leases
Sec. 311. Facilitating sharing of medical facilities with other Federal
agencies.
Sec. 312. Review of enhanced use leases.
TITLE IV--INNOVATIVE PILOT PROGRAMS
Sec. 401. Pilot program to establish or affiliate with graduate medical
residency programs at facilities operated
by Indian tribes, tribal organizations, and
the Indian Health Service in rural areas.
Sec. 402. Authority for Department of Veterans Affairs Center for
Innovation for Care and Payment.
TITLE V--OTHER HEALTH CARE MATTERS
Sec. 501. Authorization of appropriations for health care from
Department of Veterans Affairs.
Sec. 502. Appropriation of amounts for Veterans Choice Program.
Sec. 503. Applicability of Directive of Office of Federal Contract
Compliance Programs.
Sec. 504. Amending statutory requirements for the position of the Chief
Officer of the Readjustment Counseling
Service.
Sec. 505. Authorization of certain major medical facility projects of
the Department of Veterans Affairs.
SEC. 2. REFERENCES TO TITLE 38, UNITED STATES CODE.
Except as otherwise expressly provided, whenever in this Act an
amendment or repeal is expressed in terms of an amendment to, or repeal
of, a section or other provision, the reference shall be considered to
be made to a section or other provision of title 38, United States
Code.
TITLE I--DEVELOPING AN INTEGRATED HIGH-PERFORMING NETWORK
Subtitle A--Establishing the Veterans Community Care Program
SEC. 101. ESTABLISHMENT OF VETERANS COMMUNITY CARE PROGRAM.
(a) Establishment.--
(1) In general.--Section 1703 is amended to read as
follows:
``Sec. 1703. Veterans Community Care Program
``(a) In General.--(1) Subject to the availability of
appropriations for such purpose and subject to paragraph (4), hospital
care, medical services, and extended care services under this chapter
shall be furnished to a covered veteran described in subsection (b) by
health care providers specified in subsection (c) in accordance with
this section.
``(2) The furnishing of care and services under this section may be
referred to as the `Veterans Community Care Program'.
``(3)(A) In carrying out this section, the Secretary may develop
categories of certain health care providers specified in subsection (c)
for the purpose of providing a covered veteran hospital care, medical
services, and extended care services when the covered veteran does not
state a preference for a health care provider.
``(B) In developing categories of health care providers under
subparagraph (A), the Secretary shall not--
``(i) prioritize or rank such categories in a manner that
limits the options a covered veteran may have in selecting a
health care provider specified in subsection (c); or
``(ii) direct a covered veteran to receive care or services
from certain health care providers instead of other health care
providers.
``(4) In carrying out this section, the Secretary shall not limit
any hospital care, medical service, extended care service, or class of
hospital care, medical service, or extended care service that are set
forth in the Medical Benefits Package of the Department, as modified as
determined by the Secretary.
``(b) Covered Veterans.--For purposes of this section, a covered
veteran is any veteran who--
``(1)(A) is enrolled in the patient enrollment system of
the Department established and operated under section 1705 of
this title; or
``(B) is not enrolled in such system but is otherwise
entitled to hospital care, a medical service, or an extended
care service under subsection (c)(2) of such section; and
``(2)(A) has been furnished hospital care or medical
services under this chapter on at least one occasion during the
preceding two-year period; or
``(B) requested a first-time appointment for hospital care
or medical services at a Department facility.
``(c) Health Care Providers Specified.--Health care providers
specified in this subsection are the following:
``(1) 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 a program.
``(2) The Department of Defense.
``(3) The Indian Health Service.
``(4) 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))).
``(5) Any health care provider not otherwise covered under
any of paragraphs (1) through (4) that meets criteria
established by the Secretary for purposes of this section.
``(d) Contracts To Establish Networks of Health Care Providers.--
(1) The Secretary shall enter into consolidated, competitively bid
contracts, which may be regional contracts, to establish networks of
non-Department health care providers specified in paragraphs (1) and
(5) of subsection (c) for contract purposes of--
``(A) providing sufficient access to hospital care, medical
services, and extended care services under this section;
``(B) managing the operations of such health care
providers; and
``(C) managing the delivery of hospital care, medical
services, and extended care services under this section.
``(2) The Secretary may terminate a contract with an entity entered
into under paragraph (1) at such time and upon such notice to the
entity as the Secretary may specify for purposes of this section.
``(3)(A) Whenever the Secretary provides notice to an entity under
paragraph (2) that the entity is failing to meet contractual
obligations entered into under paragraph (1), 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 such failure and the decision of the Secretary to terminate the
contract under paragraph (2).
``(B) Each report submitted under subparagraph (A) shall include
the following:
``(i) An explanation of the reasons for terminating the
contract.
``(ii) A description of the effect of the failure of the
entity to meet contractual obligations and the termination of
the contract, including with respect to cost, schedule, and
requirements.
``(iii) A description of the actions taken by the Secretary
to mitigate such failure and termination.
``(e) Coordination of Care and Services.--(1) The Secretary shall
ensure that for each covered veteran seeking care or services under
this section, a care coordination team is provided by a medical
facility of the Department.
``(2) The Secretary shall ensure that each care coordination team
provided under this section, with respect to a covered veteran, is
responsible for the following:
``(A) Coordination and management of hospital care, medical
services (including telemedicine), and extended care services
furnished under this title, including the following:
``(i) Collaboration with the patient aligned care
teams (PACT) within the medical facility of the
Department; and
``(ii) Coordination within and across Veterans
Integrated Service Networks with non-Department health
care providers acting under a contract or agreement to
furnish hospital care, a medical service, or an
extended care service on behalf of the Department and
who meets such terms and conditions as the Secretary
may require.
``(B) Ensure continuity of care for the covered veteran to
avoid any delay or lapse in care or services from an action or
error of the Department or any individual of the care
coordination team of the covered veteran.
``(C) Submitting information to the Secretary in
furtherance of analysis conducted under section 1730B(a) of
this title.
``(3) The Secretary shall develop an organizational construct for
care coordination teams at medical facilities of the Department that
may include the following individuals:
``(A) An employee of the Department who furnishes hospital
care, a medical service, or an extended care service at the
facility.
``(B) A non-Department health care provider acting under a
contract or agreement to furnish hospital care, a medical
service, or an extended care service on behalf of the
Department and who meets such terms and conditions as the
Secretary may require.
``(C) An employee of the Department or a health care
provider described in subparagraph (B) who serves to seamlessly
coordinate the delivery of hospital care, medical services, and
extended care services to covered veterans.
``(f) Eligibility Reform and Conditions That Require Access to
Community Care.--(1) Subject to the availability of appropriations, the
Secretary shall furnish hospital care, medical services, and extended
care services to a covered veteran, at the election of a covered
veteran, through health care providers specified in subsection (c) as
follows:
``(A) When a medical facility of the Department does not
offer the hospital care, medical services, or extended care
services the covered veteran requires.
``(B) When a medical facility of the Department cannot
furnish or schedule an appointment for hospital care, medical
services, or extended care services in accordance with access
standards established under section 1703B of this title.
``(C) When the covered veteran and a referring clinician of
the covered veteran agree that furnishing hospital care,
medical services, or extended care services through a non-
Department entity or provider would be in the best medical
interest of the covered veteran, after consideration of the
standards established under sections 1703B and 1703C of this
title or due to a non-clinical reason, compelling circumstance,
or other considerations that are in the best medical interest
of the covered veteran.
``(2) Not later than 120 days after the date of the enactment of
the Veterans Community Care and Access Act of 2017, the Secretary shall
submit to the appropriate committees of Congress a report describing
the guidelines and standards the Secretary intends to use to carry out
paragraph (1) in accordance with sections 1703B and 1703C of this
title.
``(g) Scheduling Services.--(1) The Secretary shall ensure that
services are established in order to schedule appointments for hospital
care, medical services, and extended care services under this chapter.
``(2)(A) In carrying out paragraph (1), the Secretary shall
determine whether services established under such paragraph should
reside within the respective medical facility of the Department or
reside with an entity with whom the Secretary enters into a contract
for such services.
``(B) In carrying out subparagraph (A), the Secretary shall assess
the following:
``(i) Whether a medical facility of the Department is
currently managing scheduling services and the Secretary
determines such medical facility has the capability to continue
to manage scheduling.
``(ii) Whether a medical facility of the Department has the
capacity to manage scheduling services based on the following:
``(I) An initial review of the medical facility to
acquire scheduling service responsibilities and the
preference of the medical facility to acquire such
responsibilities.
``(II) The market area assessment currently
underway pursuant to section 1730B(c) of this title.
``(III) The capacity of the medical facility to
perform scheduling services that meet standards
established under sections 1703B and 1703C of this
title.
``(iii) Whether one or more contracts were in effect on the
day before the date of the enactment of the Veterans Community
Care and Access Act of 2017 that include scheduling services,
as determined by the Secretary, and may be modified by the
Secretary for services under this subsection.
``(h) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
``(2) The term `clinician' has the meaning given that term
by the Centers for Medicare & Medicaid Services and includes
Doctors of Medicine (MD), Doctors of Osteopathy (DO), Doctors
of Dental Surgery or Dental Medicine (DMD/DDS), Doctors of
Podiatry, Doctors of Optometry, Chiropractors, Physician
Assistants (PA), Nurse Practitioners (NP), Clinical Nurse
Specialists, Certified Registered Nurse Anesthetists, and such
other health professionals as the Secretary may specify for
purposes of this section.
``(3) The term `medical facility of the Department'
includes a medical center, a community-based outpatient clinic,
an outpatient clinic, or any other facility of the Department
at which hospital care, medical services, or extended care
services are furnished.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by striking
the item relating to section 1703 and inserting the following
new item:
``1703. Veterans Community Care Program.''.
(b) Regulations.--Not later than one year after the date of the
enactment of this Act, the Secretary of Veterans Affairs shall
promulgate regulations to carry out section 1703 of title 38, United
States Code, as amended by subsection (a).
(c) Effective Date.--The amendments made by subsection (a) shall
take effect on the date that the Secretary promulgates regulations
under subsection (b).
SEC. 102. STRATEGY REGARDING THE HIGH PERFORMING INTEGRATED HEALTHCARE
NETWORK OF THE DEPARTMENT.
(a) In General.--Subchapter III of chapter 17 is amended by
inserting after section 1730A the following new section:
``Sec. 1730B. Quadrennial Veterans Health Administration review,
management of high-performing integrated healthcare
network, and market area assessments
``(a) Quadrennial Veterans Health Administration Review.--(1) Not
later than one year after the date of the enactment of the Veterans
Community Care and Access Act of 2017 and not less frequently than once
every four years thereafter, the Secretary shall conduct a
comprehensive examination (to be known as a `quadrennial Veterans
Health Administration review') of programs and policies of the
Department regarding the delivery of health care services and the need
for health care services for veterans in future years.
``(2) The Secretary shall designate an individual in a Senior
Executive Service position (as defined in section 3132(a) of title 5)
or equivalent as the Director of the High-Performing Integrated
Healthcare Network of the Department (in this section referred to as
the `Director') who shall be responsible for carrying out this section
and advising the Secretary and the Under Secretary for Health on
matters pertaining to this section.
``(3) Each quadrennial Veterans Health Administration review
conducted under paragraph (1) shall include a strategic plan to meet
future requirements and demand for hospital care, medical services, and
extended care services under the laws administered by the Secretary
that includes a five-year budget forecast for meeting such requirements
and demand based on the information contained in the market area
assessments conducted under subsection (c) and such other information
as the Secretary considers appropriate.
``(4) In preparing the quadrennial Veterans Health Administration
review under paragraph (1), including the strategic plan under
paragraph (3), the Secretary shall--
``(A) consider the access and quality standards established
under sections 1703B and 1703C of this title, respectively;
``(B) consider the needs of the Department to furnish
health care services to veterans based on--
``(i) identified health care services that provide
management of health conditions or disorders related to
military service for which there is limited experience
or access to such health care services from non-
Department health care providers in the commercial
market;
``(ii) the overall health of veterans throughout
their lifespan; or
``(iii) such other services as the Secretary
determines appropriate;
``(C) consult with key stakeholders within the Department,
the heads of other Federal agencies, and other relevant
governmental and nongovernmental entities, including State,
local, and tribal government officials, members of Congress,
veterans service organizations, private sector representatives,
academics, and other policy experts;
``(D) identify emerging issues, trends, problems, and
opportunities that could affect health care services furnished
under the laws administered by the Secretary;
``(E) develop recommendations regarding both short- and
long-term priorities for health care services furnished under
the laws administered by the Secretary;
``(F) compare the Veterans Equitable Resource Allocation
(VERA) system to other resource allocation systems or models
for the purpose of analyzing the effectiveness of such systems
in allocating resources to furnish hospital care, medical
services, and extended care services to veterans; and
``(G) consider the work of the Center for Innovation for
Care and Payment under section 1703F of this title with respect
to research, development, and testing payment and service
delivery models.
``(b) Management of High-Performing Integrated Healthcare
Network.--(1) The Director shall be responsible for the management,
design, implementation, and assessment of the high-performing
integrated healthcare network of the Department.
``(2) In managing, designing, implementing, and assessing the high-
performing integrated healthcare network of the Department under this
subsection, the Director shall be responsible for the following:
``(A) Overseeing the transformation and organizational
change across the Department to achieve such high-performing
integrated healthcare network.
``(B) Developing and implementing the quadrennial Veterans
Health Administration review and strategic plan under
subsection (a).
``(C) Overseeing the market area assessments performed
under subsection (c).
``(D) Developing the capital infrastructure planning and
procurement processes, whether minor or major construction
projects or leases, in coordination with other offices of the
Department.
``(E) Developing a multi-year budget process that is
capable of forecasting future year budget requirements and
projecting the cost of delivering health care services under a
high-performing integrated healthcare network.
``(3) To ensure that the Director is able to carry out the
responsibilities under paragraph (2), the Secretary shall ensure that
coordination and information sharing occurs with other relevant offices
of the Department, including the following offices:
``(A) The Office of Management.
``(B) The Office of Acquisition, Logistics and
Construction.
``(C) The Office of Information and Technology.
``(4) In carrying out this subsection, the Director shall confer
with the Director of the Defense Health Agency and consider best
practices and recommendations from non-Department entities, including
entities carrying out market area assessments under subsection (c),
that have developed plans, implemented systems, or advised other
healthcare systems.
``(5)(A) Not less frequently than once every three months, the
Secretary or the Director shall brief the appropriate committees of
Congress on the activities conducted under this subsection.
``(B) Each briefing conducted under subparagraph (A) shall include
the following:
``(i) An assessment of any remediation or improvement
conducted by the Department with respect to a medical service
line of the Department that the Secretary has determined does
not meet an access standard or standard for quality established
under section 1703B or 1703C of this title, respectively, in
providing hospital care, a medical service, or an extended care
service, including the following:
``(I) An assessment of the factors that led the
Secretary to make such determination.
``(II) An assessment of the medical service line in
relation to the market area assessment most recently
performed under subsection (c), particularly with
respect to how it relates to the demand for the medical
service line in the area and by veterans using a
medical facility of the Department for such medical
service line.
``(III) A plan with specific actions, and the time
to complete them, to meet the access standards and
standards for quality established under sections 1703B
and 1703C of this title, respectively, which shall
include consideration of--
``(aa) increasing personnel or temporary
personnel assistance, including mobile
deployment teams;
``(bb) special hiring incentives, including
the Education Debt Reduction Program under
subchapter VII of chapter 76 of this title and
recruitment, relocation, and retention
incentives;
``(cc) using direct hiring authority;
``(dd) providing improved training
opportunities for staff;
``(ee) acquiring improved equipment;
``(ff) making structural modifications to
the facility used by the medical service line;
``(gg) partnering with health care
providers that have the capacity to meet the
demand in the market area and meet access and
quality standards established under sections
1703B and 1703C of this title; and
``(hh) such other actions as the Secretary
considers appropriate.
``(ii) An assessment of the progress made by the Department
with respect to the responsibilities of the Director under
paragraph (2).
``(c) Market Area Assessments.--(1) Not less frequently than once
every four years, the Secretary shall perform market area assessments
regarding the health care services furnished under the laws
administered by the Secretary.
``(2) Each market area assessment performed under paragraph (1)
shall include the following:
``(A) An assessment of the demand for hospital care,
medical services, and extended care services from the
Department, disaggregated by geographic market areas that are
consistent with industry market areas or boundaries, including
the number of requests for such care and services under the
laws administered by the Secretary.
``(B) An inventory of the health care capacity of the
Department across the facilities of the Department.
``(C) An assessment of the health care capacity to be
provided through contracted community care providers and
providers who entered into a provider agreement with the
Department under section 1703A of this title, including the
number of providers, the geographic location of the providers,
and categories or types of health care services provided by the
providers.
``(D) An assessment obtained from other Federal direct
delivery systems of their capacity to provide health care to
veterans.
``(E) An assessment of the health care capacity of non-
contracted providers where there is insufficient network
supply.
``(F) An assessment of the health care capacity of academic
affiliates and other collaborations of the Department as it
relates to providing health care to veterans.
``(G) An assessment of the effects on health care capacity
by the access and quality standards established under sections
1703B and 1703C of this title, respectively.
``(H) The number of appointments for health care services
under the laws administered by the Secretary, disaggregated
by--
``(i) appointments at facilities of the Department;
and
``(ii) appointments with non-Department health care
providers.
``(I) Analysis of information submitted from care
coordination teams under section 1703(e)(2)(D) of this title
from each Department medical facility that includes the
following:
``(i) An analysis of coordination and management
best practices.
``(ii) Satisfaction survey data from the covered
veterans from each care coordination team under section
1703(e) of this title.
``(iii) Findings and determinations related to the
coordination of care under section 1703(e) of this
title to assist the Director in the design,
implementation, and assessment of the high-performing
integrated healthcare network of the Department.
``(iv) A standardized climate survey developed
jointly with the Centers for Medicare & Medicaid
Services Alliance to Modernize Healthcare (CAMH) for
the employees of each medical facility of the
Department that compiles data on culture,
communication, teamwork, quality of worklife, rewards
or recognition, leadership, and productivity.
``(3) The Secretary shall submit to the appropriate committees of
Congress each market area assessment performed under paragraph (1) and
the complete market area assessment being performed on the day before
the date of the enactment of the Veterans Community Care and Access Act
of 2017 in the same form as such assessments are delivered to the
Secretary.
``(4) The Secretary shall use the market area assessments performed
under paragraph (1) to inform the quadrennial Veterans Health
Administration review and strategic plan under subsection (a) and to
determine the capacity of the Department and the capacity of the health
care provider networks established under section 1703(d) of this title.
``(5) The Secretary shall publish the capacity findings and results
from the market area assessments performed under paragraph (1) with
respect to the Department and health care provider networks established
under section 1703(d) of this title on a publicly accessible Internet
website of the Department.
``(d) Department Budget.--The Secretary shall ensure that the
budget request of the Department for any fiscal year (as submitted with
the budget of the President under section 1105(a) of title 31) reflects
the findings of the Secretary with respect to the most recent
information described in subsection (b)(5) and is consistent with the
quadrennial Veterans Health Administration review and strategic plan
under subsection (a).
``(e) Appropriate Committees of Congress Defined.--In this section,
the term `appropriate committees of Congress' means--
``(1) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(2) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 is amended by inserting after the item relating to section
1730A the following new item:
``1730B. Quadrennial Veterans Health Administration review, management
of high-performing integrated healthcare
network, and market area assessments.''.
(c) Waiver of Certain Requirements for Market Assessment in
Progress.--Paragraph (2) of section 1730B(c) of title 38, United States
Code, as added by subsection (a), shall not apply to a market area
assessment that was being performed by the Secretary of Veterans
Affairs on the day before the date of the enactment of this Act.
SEC. 103. ACCESS STANDARDS AND STANDARDS FOR QUALITY.
(a) In General.--Subchapter I of chapter 17 is amended by inserting
after section 1703 the following new sections:
``Sec. 1703B. Access standards
``(a) In General.--(1) The Secretary shall establish access
standards for hospital care, medical services, and extended care
services furnished by the Department, including through health care
providers under section 1703 of this title.
``(2) The Secretary shall ensure that the hospital care, medical
services, and extended care services furnished to a veteran by the
Department, including through health care providers under section 1703
of this title, is furnished within the access standards established
under paragraph (1).
``(3) The access standards established under paragraph (1) shall
align with the categories of hospital care, medical services, and
extended care services set forth under subsection (b) and shall be
informed by the market area assessments performed under section
1730B(c) of this title.
``(b) Categories of Hospital Care, Medical Services, and Extended
Care Services Furnished.--The categories of hospital care, medical
services, and extended care services subject to access standards
established under subsection (a) are as follows:
``(1) Primary care services.
``(2) Specialty care services, including services that may
require a referral and services that may be considered wellness
or preventative care.
``(3) Behavioral health services, including mental health
and substance abuse disorder treatment.
``(4) Urgent care.
``(5) Home health services, including services that may be
virtual.
``(6) Dental services.
``(7) As determined by the Secretary, any additional types
of services for which the Department or the networks
established under section 1703(d) of this title have
experienced increased demand according to the market area
assessments performed under section 1730B(c) of this title or
an increase in access complaints to network health care
providers or the Department.
``(c) Application.--(1) The Secretary may establish and apply
access standards under subsection (a) according to the market area
assessments under section 1730B(c) of this title.
``(2) In carrying out section 1703 of this title, the Secretary
shall apply access standards established under subsection (a) to a
covered veteran under such section with respect to the residence, as
defined in section 17.1505 of title 38, Code of Federal Regulations (or
any successor regulation), of the covered veteran.
``(d) Comparative Information.--The Secretary shall ensure that the
access standards required by subsection (a) provide veterans, employees
of the Department, and health providers in the Veterans Community Care
Program established under section 1703 of this title with relevant
comparative information that is clear, useful, and timely, so that
veterans can make informed and responsible decisions regarding their
hospital care, medical services, and extended care services.
``(e) Coordination.--The Secretary shall coordinate with the
Secretary of Defense, and may consult with the Secretary of Health and
Human Services, the Administrator of the Centers for Medicare &
Medicaid Services, entities in the private sector, and other
nongovernmental entities in establishing access standards under
subsection (a).
``(f) Periodic Review.--Not later than two years after the date on
which the Secretary establishes access standards under this section and
not less frequently than once every three years thereafter, the
Secretary shall--
``(1) conduct a review of such standards; and
``(2) submit to the appropriate committees of Congress a
report that includes the following:
``(A) A report on the findings of the Secretary
with respect to the review conducted under paragraph
(1) and any modification to such standards as the
Secretary considers appropriate.
``(B) For each medical service line that the
Secretary determined, during the period covered by the
report, did not meet a standard established under this
section, identification of the leadership team in the
facility and the Veterans Integrated Service Network
that are responsible for overseeing the progress of the
medical service line in meeting such standard.
``(g) Publication.--The Secretary shall publish the health care
access standards established under subsection (a) and any modifications
to such standards in the Federal Register and on a publicly accessible
Internet website of the Department.
``(h) Appropriate Committees of Congress Defined.--In this section,
the term `appropriate committees of Congress' means--
``(1) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(2) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``Sec. 1703C. Standards for quality
``(a) In General.--(1) The Secretary shall establish standards for
quality regarding hospital care, medical services, and extended care
services furnished by the Department, including through health care
providers under section 1703 of this title.
``(2) The Secretary shall ensure that the hospital care, medical
services, and extended care services furnished to a veteran by the
Department, including through health care providers under section 1703
of this title, is furnished within the standards for quality
established under paragraph (1).
``(3) The standards for quality established under paragraph (1)
shall align with the Department of Defense according to categories of
hospital care, medical services, and extended care services set forth
under section 1703B(b) of this title and shall be informed by the
market area assessments performed under section 1730B(c) of this title.
``(4) In establishing standards for quality under paragraph (1),
the Secretary shall--
``(A) conduct a survey of covered veterans described in
section 1703(b) of this title through a third party entity to
assess the satisfaction of such veterans with service and
quality of care; and
``(B) collect data sets that include, at a minimum--
``(i) general information;
``(ii) surveys of patients' experiences;
``(iii) timely and effective care;
``(iv) complications;
``(v) readmissions and deaths;
``(vi) use of medical imaging;
``(vii) payment and value of care; and
``(viii) use of telemedicine.
``(5) The Secretary shall develop such standards for quality and
collect data according to health care settings consistent with the
Department of Defense and the Centers for Medicare & Medicaid Services,
including, at a minimum, the following:
``(A) Inpatient hospitals.
``(B) Nursing homes.
``(C) Individual health care providers.
``(D) Dialysis facilities.
``(E) Hospice.
``(F) Inpatient rehabilitation facilities.
``(G) Long-term care hospitals.
``(H) Outpatient facilities.
``(6) The standards for quality established under paragraph (1)
shall be informed by existing health quality measures, such as those
defined by the HealthCare Effectiveness Data and Information Set, that
are applied to public and privately sponsored health care systems with
the purpose of providing veterans relevant comparative information to
make informed decisions regarding their health care.
``(b) Improving and Strengthening Quality Standards.--Not later
than one year after the date on which the Secretary establishes
standards under subsection (a), the Secretary shall--
``(1) publish the quality rating of medical facilities of
the Department on a publicly available Internet website, such
as a website of the Centers for Medicare & Medicaid Services,
for the purpose of providing veterans with information that
allows them to compare performance measure information among
Department and community health care providers who provide
hospital care, medical services, or extended care services
under section 1703 of this title; and
``(2) consider and solicit public comment on potential
changes to the established quality measures to ensure that they
include the most up-to-date and applicable industry measures
for veterans.
``(c) Coordination.--The Secretary shall coordinate with the
Secretary of Defense, and may consult with the Secretary of Health and
Human Services, the Administrator of the Centers for Medicare &
Medicaid Services, entities in the private sector, and other
nongovernmental entities in establishing standards for quality under
this section.
``(d) Periodic Review.--Not later than two years after the date on
which the Secretary establishes standards for quality under this
section and not less frequently than once every three years thereafter,
the Secretary shall--
``(1) conduct a review of such standards across the
Department; and
``(2) submit to the appropriate committees of Congress a
report that includes the following:
``(A) A report on the findings of the Secretary
with respect to the review conducted under paragraph
(1) and any modification to such standards as the
Secretary considers appropriate.
``(B) For each medical service line that the
Secretary determined, during the period covered by the
report, did not meet a standard established under this
section, identification of the leadership team in the
facility and the Veterans Integrated Service Network
that are responsible for overseeing the progress of the
medical service line in meeting such standard.
``(e) Publication.--The Secretary shall publish the health care
quality standards established under subsection (a) and any
modifications to such standards in the Federal Register and on a
publicly accessible Internet website of the Department.
``(f) Appropriate Committees of Congress Defined.--In this section,
the term `appropriate committees of Congress' means--
``(1) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(2) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17, as amended by section 102, is further amended by inserting
after the item relating to section 1703 the following new items:
``1703B. Access standards.
``1703C. Standards for quality.''.
(c) Submittal of Access Standards and Standards for Quality.--
(1) In general.--Not later than July 1, 2018, the Secretary
of Veterans Affairs shall submit to the appropriate committees
of Congress a report detailing the access standards and
standards for quality established under sections 1703B and
1703C of title 38, United States Code, respectively, as added
by subsection (a).
(2) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
Subtitle B--Forming Partnerships and Agreements
SEC. 111. CONTINUITY OF CARE AND EXISTING AGREEMENTS.
(a) In General.--Notwithstanding section 1703 of title 38, United
States Code, as amended by section 101 of this Act, the Secretary of
Veterans Affairs shall ensure veterans do not experience a delay or
lapse in care or services by continuing the following:
(1) All contracts, memorandums of understanding, and
memorandums of agreements that were in effect on the day before
the date of the enactment of this Act between the Department of
Veterans Affairs and the American Indian and Alaska Native
health care systems as established under the auspices of the
Department of Veterans Affairs and Indian Health Service
Memorandum of Understanding, signed October 1, 2010.
(2) The National Reimbursement Agreement, signed December
5, 2012.
(3) Agreements that were in effect on the day before the
date of the enactment of this Act and entered into under
section 101, 102, or 103 of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146).
(4) Agreements that were in effect on the day before the
date of the enactment of this Act for the purpose of dialysis
treatment, only if the contracts or agreements established
under section 1703 of title 38, United States Code, as amended
by section 101 of this Act, do not stipulate that such
treatments be furnished by providers under such contracts or
agreements.
(b) Modifications.--Subsection (a) shall not be construed to
prohibit the Secretary and the parties to the contracts, agreements,
memorandums of understanding, and memorandums of agreements described
in such subsection from making such changes to such contracts,
agreements, memorandums of understanding, and memorandums of agreements
as may be otherwise authorized pursuant to other provisions of law or
the terms of the contracts, agreements, memorandums of understanding,
and memorandums of agreements.
(c) Treatment of Existing Contractors.--To the extent practicable,
the Secretary shall give health care providers who are providing
hospital care, medical services, or extended care services pursuant to
a contract with the Secretary under section 1703 of title 38, United
States Code, as in effect on the day before the date of the enactment
of this Act, the opportunity to furnish hospital care, medical
services, or extended care services under such section as amended by
section 101 of this Act.
SEC. 112. AUTHORIZATION OF AGREEMENTS BETWEEN DEPARTMENT OF VETERANS
AFFAIRS AND NON-DEPARTMENT PROVIDERS.
(a) In General.--Subchapter I of chapter 17, as amended by sections
101 and 103, is further amended by inserting after section 1703 the
following new section:
``Sec. 1703A. Agreements with eligible entities or providers;
certification processes
``(a) Agreements Authorized.--(1)(A) 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.
``(B) 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'.
``(C) 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.
``(D) A Veterans Care Agreement may be entered into by the
Secretary or any Department official authorized by the Secretary.
``(2)(A) 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.
``(B)(i) 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.
``(ii) 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).
``(3) 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.
``(4)(A) 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.
``(B) 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.
``(C) In this paragraph, the term `appropriate committees of
Congress' means--
``(i) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(ii) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.
``(b) Eligible Entities and Providers.--For purposes of this
section, an eligible entity or provider is--
``(1) 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));
``(2) any provider participating under a State plan under
title XIX of such Act (42 U.S.C. 1396 et seq.); or
``(3) 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).
``(c) Eligible Entity or Provider Certification Process.--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--
``(1) establish deadlines for actions on applications for
certification;
``(2) 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;
``(3) 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;
``(4) 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
``(5) 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.
``(d) Rates.--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.
``(e) Terms of Veterans Care Agreements.--(1) 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.
``(2) To furnish hospital care, medical services, or extended care
services under this section, an eligible entity or provider shall
agree--
``(A) to accept payment at the rates established in
regulations prescribed under this section;
``(B) 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;
``(C) 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;
``(D) to bill the Department in accordance with the
methodology outlined in regulations prescribed under this
section;
``(E) 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;
``(F) to provide medical records to the Department in the
time frame and format specified by the Department; and
``(G) to meet such other terms and conditions, including
quality of care assurance standards, as the Secretary may
specify in regulation.
``(f) Discontinuation or Nonrenewal of a Veterans Care
Agreements.--(1) 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.
``(2) 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--
``(A) 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;
``(B) 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;
``(C) 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
``(D) has determined that it is reasonable to terminate the
agreement based on the health care needs of a veteran.
``(g) Quality of Care.--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.
``(h) Disputes.--(1) The Secretary shall promulgate administrative
procedures for eligible entities and providers to present all disputes
arising under or related to Veterans Care Agreements.
``(2) Such procedures constitute the eligible entities' and
providers' exhaustive and exclusive administrative remedies.
``(3) 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').
``(4) 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.
``(i) Applicability of Other Provisions of Law.--(1) 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.
``(2)(A) 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.
``(B) An eligible entity or provider that enters into an agreement
under this section is subject to--
``(i) all laws regarding integrity, ethics, or fraud, or
that subject a person to civil or criminal penalties; and
``(ii) all laws that protect against employment
discrimination or that otherwise ensure equal employment
opportunities.
``(j) Parity of Treatment.--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.
``(k) Rulemaking.--The Secretary shall promulgate regulations to
carry out this section.''.
(b) Clerical Amendment.--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.''.
SEC. 113. PREVENTION OF CERTAIN HEALTH CARE PROVIDERS FROM PROVIDING
NON-DEPARTMENT HEALTH CARE SERVICES TO VETERANS.
(a) In General.--On and after the date that is one year after the
date of the enactment of this Act, the Secretary of Veterans Affairs
shall deny or revoke the eligibility of a health care provider to
provide non-Department health care services to veterans if the
Secretary determines that the health care provider--
(1) was removed from employment with the Department of
Veterans Affairs due to conduct that violated a policy of the
Department relating to the delivery of safe and appropriate
health care; or
(2) violated the requirements of a medical license of the
health care provider that resulted in the loss of such medical
license.
(b) Permissive Action.--On and after the date that is one year
after the date of the enactment of this Act, the Secretary may deny,
revoke, or suspend the eligibility of a health care provider to provide
non-Department health care services if the Secretary determines such
action is necessary to immediately protect the health, safety, or
welfare of veterans and the health care provider is under investigation
by the medical licensing board of a State in which the health care
provider is licensed or practices.
(c) Suspension.--The Secretary shall suspend the eligibility of a
health care provider to provide non-Department health care services to
veterans if the health care provider is suspended from serving as a
health care provider of the Department.
(d) Comptroller General Report.--Not later than two years after the
date of the enactment of this Act, the Comptroller General of the
United States shall submit to Congress a report on the implementation
by the Secretary of this section, including the following:
(1) The aggregate number of health care providers denied or
suspended under this section from participation in providing
non-Department health care services.
(2) An evaluation of any impact on access to health care
for patients or staffing shortages in programs of the
Department providing non-Department health care services.
(3) An explanation of the coordination of the Department
with the medical licensing boards of States in implementing
this section, the amount of involvement of such boards in such
implementation, and efforts by the Department to address any
concerns raised by such boards with respect to such
implementation.
(4) Such recommendations as the Comptroller General
considers appropriate regarding harmonizing eligibility
criteria between health care providers of the Department and
health care providers eligible to provide non-Department health
care services.
(e) Non-Department Health Care Services Defined.--In this section,
the term ``non-Department health care services'' means hospital care,
medical services, and extended care services furnished at non-
Department facilities under chapter 17 of title 38, United States Code.
SEC. 114. CONFORMING AMENDMENTS FOR STATE VETERANS HOMES.
(a) In General.--Section 1745(a) is amended--
(1) in paragraph (1), by striking ``(or agreement under
section 1720(c)(1) of this title)'' and inserting ``(or an
agreement)''; and
(2) by adding at the end the following new paragraph:
``(4)(A) An agreement under this section may be authorized by the
Secretary or any Department official authorized by the Secretary, and
any such action is not an award for purposes of such laws that would
otherwise require the use of competitive procedures for the furnishing
of hospital care, medical services, and extended care services.
``(B)(i) Except as provided in clause (ii), and unless otherwise
provided in this section or regulations prescribed pursuant to this
section, a State home that enters into an agreement under this section
is not subject to, in the carrying out of the agreement, any provision
of 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.
``(ii) A State home that enters into an agreement under this
section is subject to--
``(I) all provisions of law regarding integrity, ethics, or
fraud, or that subject a person to civil or criminal penalties;
and
``(II) all provisions of law that protect against
employment discrimination or that otherwise ensure equal
employment opportunities.
``(iii) Notwithstanding subparagraph (B)(ii)(I), a State home that
enters into an agreement under this section may not be treated as a
Federal contractor or subcontractor for purposes of chapter 67 of title
41 (known as the `McNamara-O'Hara Service Contract Act of 1965').''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to care provided on or after the effective date of regulations
issued by the Secretary of Veterans Affairs to carry out this section.
Subtitle C--Paying Providers
SEC. 121. PROMPT PAYMENT TO PROVIDERS.
(a) In General.--Subchapter I of chapter 17 is amended by inserting
after section 1703C, as added by section 103 of this Act, the following
new section:
``Sec. 1703D. Prompt payment standard
``(a) In General.--(1) Notwithstanding any other provision of this
title or of any other provision of law, the Secretary shall pay for
hospital care, medical services, or extended care services furnished by
health care entities or providers under this chapter within 45 calendar
days upon receipt of a clean paper claim or 30 calendar days upon
receipt of a clean electronic claim.
``(2) If a claim is denied, the Secretary shall, within 45 calendar
days of denial for a paper claim and 30 calendar days of denial for an
electronic claim, notify the health care entity or provider of the
reason for denying the claim and what, if any, additional information
is required to process the claim.
``(3) Upon the receipt of the additional information, the Secretary
shall ensure that the claim is paid, denied, or otherwise adjudicated
within 30 calendar days from the receipt of the requested information.
``(4) This section shall only apply to payments made on an invoice
basis and shall not apply to capitation or other forms of periodic
payment to entities or providers.
``(b) Submittal of Claims by Health Care Entities and Providers.--A
health care entity or provider that furnishes hospital care, medical
services, or extended care services under this chapter shall submit to
the Secretary a claim for payment for furnishing the care or services
not later than 180 days after the date on which the entity or provider
furnished the care or services.
``(c) Fraudulent Claims.--(1) Sections 3729 through 3733 of title
31 shall apply to fraudulent claims for payment submitted to the
Secretary by a health care entity or provider under this chapter.
``(2) Pursuant to regulations prescribed by the Secretary, the
Secretary shall bar a health care entity or provider from furnishing
hospital care, medical services, and extended care services under this
chapter when the Secretary determines the entity or provider has
submitted to the Secretary fraudulent health care claims for payment by
the Secretary.
``(d) Overdue Claims.--(1) Any claim that has not been denied with
notice, made pending with notice, or paid to the health care entity or
provider by the Secretary shall be overdue if the notice or payment is
not received by the entity or provider within the time periods
specified in subsection (a).
``(2)(A) If a claim is overdue under this subsection, the Secretary
may, under the requirements established by subsection (a) and
consistent with the provisions of chapter 39 of title 31 (commonly
referred to as the `Prompt Payment Act'), require that interest be paid
on clean claims.
``(B) Interest paid under subparagraph (A) shall be computed at the
rate of interest established by the Secretary of the Treasury under
section 3902 of title 31 and published in the Federal Register.
``(e) Overpayment.--(1) The Secretary shall deduct the amount of
any overpayment from payments due a health care entity or provider
under this chapter.
``(2) Deductions may not be made under this subsection unless the
Secretary has made reasonable efforts to notify a health care entity or
provider of the right to dispute the existence or amount of such
indebtedness and the right to request a compromise of such
indebtedness.
``(3) The Secretary shall make a determination with respect to any
such dispute or request prior to deducting any overpayment unless the
time required to make such a determination before making any deductions
would jeopardize the Secretary's ability to recover the full amount of
such indebtedness.
``(f) Information and Documentation Required.--(1) The Secretary
shall provide to all health care entities and providers participating
in a program to furnish hospital care, medical services, or extended
care services under this chapter a list of information and
documentation that is required to establish a clean claim under this
section.
``(2) The Secretary shall consult with entities in the health care
industry, in the public and private sector, to determine the
information and documentation to include in the list under paragraph
(1).
``(3) If the Secretary modifies the information and documentation
included in the list under paragraph (1), the Secretary shall notify
all health care entities and providers described in paragraph (1) not
later than 30 days before such modifications take effect.
``(g) Processing of Claims.--In processing a claim for compensation
for hospital care, medical services, or extended care services
furnished by a health care entity or provider under this chapter, the
Secretary shall act through--
``(1) a non-Department entity that is under contract or
agreement for the program established under section 1703(a) of
this title; or
``(2) a non-Department entity that specializes in such
processing for other Federal agency health care systems.
``(h) Report on Encounter Data System.--(1) Not later than 90 days
after the date of the enactment of the Veterans Community Care and
Access Act of 2017, the Secretary shall submit to the appropriate
committees of Congress a report on the feasibility and advisability of
adopting a funding mechanism similar to what is utilized by other
Federal agencies to allow a contracted entity to act as a fiscal
intermediary for the Federal Government to distribute, or pass through,
Federal Government funds for certain non-underwritten hospital care,
medical services, or extended care services.
``(2) The Secretary may coordinate with the Department of Defense,
the Department of Health and Human Services, and the Department of the
Treasury in developing the report required by paragraph (1).
``(i) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
``(2) The term `clean electronic claim' means the
transmission of data for purposes of payment of covered health
care expenses that is submitted to the Secretary which contains
substantially all of the required data elements necessary for
accurate adjudication, without obtaining additional information
from the entity or provider that furnished the care or service,
submitted in such format as prescribed by the Secretary in
regulations for the purpose of paying claims for care or
services.
``(3) The term `clean paper claim' means a paper claim for
payment of covered health care expenses that is submitted to
the Secretary which contains substantially all of the required
data elements necessary for accurate adjudication, without
obtaining additional information from the entity or provider
that furnished the care or service, submitted in such format as
prescribed by the Secretary in regulations for the purpose of
paying claims for care or services.
``(4) The term `fraudulent claims' means the intentional
and deliberate misrepresentation of a material fact or facts by
a health care entity or provider made to induce the Secretary
to pay a claim that was not legally payable to that provider.
This term, as used in this section, shall not include a good
faith interpretation by a health care entity or provider of
utilization, medical necessity, coding, and billing
requirements of the Secretary.
``(5) The term `health care entity or provider' includes
any non-Department health care entity or provider, but does not
include any Federal health care entity or provider.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item related to section
1703C, as added by section 103 of this Act, the following new item:
``1703D. Prompt payment standard.''.
SEC. 122. PAYMENT RATES FOR COMMUNITY CARE.
(a) In General.--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:
``Sec. 1703E. Payment rates for community care
``(a) In General.--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)).
``(b) Exception.--(1)(A) 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.
``(B) 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.
``(2) 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.
``(3) 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.
``(c) Value-Based Reimbursement.--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.''.
(b) Clerical Amendment.--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.''.
SEC. 123. AUTHORITY TO PAY FOR AUTHORIZED CARE NOT SUBJECT TO AN
AGREEMENT.
(a) In General.--Subchapter IV of chapter 81 is amended by adding
at the end the following new section:
``Sec. 8159. Authority to pay for services authorized but not subject
to an agreement
``(a) In General.--If, in the course of furnishing hospital care, a
medical service, or an extended care service authorized by the
Secretary and pursuant to a contract, agreement, or other arrangement
with the Secretary, a provider that is not a party to the contract,
agreement, or other arrangement furnishes hospital care, a medical
service, or an extended care service that the Secretary considers
necessary, the Secretary may compensate the provider for the cost of
such care or service.
``(b) Reports on Use of Authority.--Whenever the Secretary
compensates a provider under subsection (a) for the furnishing of
hospital care, a medical service, or an extended care service, the care
coordination team that coordinated the furnishing of such care or
service under section 1703(e)(1) of this title shall--
``(1) submit to the appropriate committees of Congress a
report on the furnishing of such care; and
``(2) analyze the future demand for such care or service
from such provider.
``(c) New Contracts and Agreements.--The Secretary shall take
reasonable efforts to enter into a contract, agreement, or other
arrangement with a provider described in subsection (a) to ensure that
future care and services authorized by the Secretary and furnished by
the provider are subject to such a contract, agreement, or other
arrangement.
``(d) Definitions.--In this section:
``(1) The term `appropriate committees of Congress' means--
``(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
``(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
``(2) The terms `hospital care' and `medical service' have
the meanings given such terms in section 1701 of this title.''.
(b) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item relating to section
8158 the following new item:
``8159. Authority to pay for services authorized but not subject to an
agreement.''.
TITLE II--STREAMLINING COMMUNITY CARE PROGRAMS
Subtitle A--Streamlining Community Care Programs
SEC. 201. ACCESS TO WALK-IN CARE.
(a) In General.--Chapter 17 is amended by inserting after section
1725 the following new section:
``Sec. 1725A. Access to walk-in care
``(a) Procedures To Ensure Access to Walk-In Care.--The Secretary
shall develop procedures to ensure that covered veterans are able to
access walk-in care from qualifying non-Department entities or
providers.
``(b) Covered Veterans.--For purposes of this section, a covered
veteran is any veteran described in section 1703(b) of this title.
``(c) Qualifying Non-Department Entities or Providers.--For
purposes of this section, a qualifying non-Department entity or
provider is a non-Department entity or provider that--
``(1) has entered into a contract or other agreement with
the Secretary to furnish services under this section; or
``(2) entered into an agreement with the Secretary that was
in effect on the day before the date of the enactment of the
Veterans Community Care and Access Act of 2017 to furnish walk-
in care.
``(d) Federally-Qualified Health Centers.--Whenever practicable,
the Secretary may use a 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))) to carry out this section.
``(e) Continuity of Care.--(1) The Secretary shall ensure
continuity of care for each covered veteran who receives a walk-in care
service under this section through the care coordination team provided
such covered veteran under section 1703(e)(1) of this title.
``(2) The Secretary shall inform and educate covered veterans on
procedures to utilize and access walk-in care under this section.
``(3) The Secretary shall develop a mechanism to coordinate with
qualifying non-Department entities or providers through the care
coordination teams provided under section 1703(e)(1) of this title that
includes the use of medical records from walk-in care providers to
accurately represent access to care, health needs of the covered
veterans, and to monitor conditions of covered veterans.
``(f) Copayments.--(1) The Secretary shall require each covered
veteran to pay the United States a copayment for each episode of walk-
in care provided under this section, except if the episode of walk-in
care for the covered veteran is related to a service-connected
disability of the covered veteran.
``(2) The Secretary may adjust the copayment required of a covered
veteran under this subsection based upon the priority group of
enrollment of the veteran, the number of episodes of care furnished to
a covered veteran during a year, and other factors the Secretary
considers appropriate under this section.
``(3) The amount or amounts of the copayments required under this
subsection shall be prescribed by the Secretary by rule.
``(4) Copayments required by this subsection shall apply
notwithstanding any other provision of law that would allow the
Secretary to offset a covered veteran's copayment obligation with
amounts recovered from a third party under section 1729 of this title.
``(g) Regulations.--Not later than one year after the date of the
enactment of the Veterans Community Care and Access Act of 2017, the
Secretary shall promulgate regulations to carry out this section.
``(h) Walk-In Care Defined.--In this section, the term `walk-in
care' means non-urgent, non-emergent, convenience care provided by a
qualifying non-Department entity or provider that furnishes episodic
care and not longitudinal management of conditions and certain services
as defined through contracts or agreements described in subsection (c)
or regulations the Secretary shall prescribe for purposes of this
section.''.
(b) Effective Date.--Section 1725A of title 38, United States Code,
as added by subsection (a) shall take effect on the date upon which
final regulations implementing such section take effect.
(c) Clerical Amendment.--The table of sections at the beginning of
such chapter is amended by inserting after the item related to section
1725 the following new item:
``Sec. 1725A. Access to walk-in care.''.
SEC. 202. VETERANS CHOICE FUND FLEXIBILITY.
Section 802 of the Veterans Access, Choice, and Accountability Act
of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended--
(1) in subsection (c)--
(A) in paragraph (1), by striking ``by paragraph
(3)'' and inserting ``in paragraphs (3) and (4)''; and
(B) by adding at the end the following new
paragraph:
``(4) Permanent authority for other uses.--Beginning in
fiscal year 2019, amounts remaining in the Veterans Choice Fund
may be used to furnish hospital care, medical services, and
extended care services to individuals pursuant to chapter 17 of
title 38, United States Code, at non-Department facilities or
through non-Department providers at Department facilities,
including pursuant to non-Department provider programs other
than the program established by section 101. Such amounts shall
be available in addition to amounts available in other
appropriations accounts for such purposes.''; and
(2) in subsection (d)(1), by striking ``to subsection
(c)(3)'' and inserting ``to paragraphs (3) and (4) of
subsection (c)''.
SEC. 203. CONFORMING AMENDMENTS.
(a) In General.--
(1) Title 38.--Title 38, United States Code, is amended--
(A) in section 1712(a)--
(i) in paragraph (3), by striking ``under
clause (1), (2), or (5) of section 1703(a) of
this title'' and inserting ``or entered an
agreement''; and
(ii) in paragraph (4)(A), by striking
``under the provisions of this subsection and
section 1703 of this title'';
(B) in section 1712A(e)(1)--
(i) by inserting ``or agreements'' after
``contracts''; and
(ii) by striking ``(under sections
1703(a)(2) and 1710(a)(1)(B) of this title)'';
and
(C) in section 2303(a)(2)(B)(i), by striking ``with
section 1703'' and inserting ``with sections 1703A,
8111, and 8153''.
(2) Social security act.--Section 1866(a)(1)(L) of the
Social Security Act (42 U.S.C. 1395cc(a)(1)(L)) is amended by
striking ``under section 1703'' and inserting ``under chapter
17''.
(3) Veterans' benefits improvements act of 1994.--Section
104(a)(4)(A) of the Veterans' Benefits Improvements Act of 1994
(Public Law 103-446; 38 U.S.C. 1117 note) is amended by
striking ``in section 1703'' and inserting ``in sections 1703A,
8111, and 8153''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date described in section 101(b)(2).
Subtitle B--Improving Information Sharing With Providers
SEC. 211. IMPROVING INFORMATION SHARING WITH COMMUNITY PROVIDERS.
Section 7332(b)(2) is amended by striking subparagraph (H) and
inserting the following new subparagraphs:
``(H)(i) To a non-Department entity (including private
entities and other Federal agencies) for purposes of providing
health care, including hospital care, medical services, and
extended care services, to patients.
``(ii) An entity to which a record is disclosed under this
subparagraph may not disclose or use such record for a purpose
other than that for which the disclosure was made.
``(I) To a third party in order to recover or collect
reasonable charges for care furnished to, or paid on behalf of,
a patient in connection with a non-service connected disability
as permitted by section 1729 of this title 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
the Act entitled `An Act to provide for the recovery from
tortiously liable third persons of the cost of hospital and
medical care and treatment furnished by the United States'
(Public Law 87-693; 42 U.S.C. 2651 et seq.; commonly known as
the `Federal Medical Care Recovery Act').''.
SEC. 212. ESTABLISHMENT OF PROCESSES TO ENSURE SAFE OPIOID PRESCRIBING
PRACTICES BY NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH
CARE PROVIDERS.
(a) Receipt and Review of Guidelines.--The Secretary of Veterans
Affairs shall ensure that all covered health care providers are
provided a copy of and certify that they have reviewed the evidence-
based guidelines for prescribing opioids set forth by the Opioid Safety
Initiative of the Department of Veterans Affairs under sections
911(a)(2) and 912(c) of the Jason Simcakoski Memorial and Promise Act
(Public Law 114-198; 38 U.S.C. 1701 note) before first providing care
under the laws administered by the Secretary and at any time when those
guidelines are modified thereafter.
(b) Inclusion of Medical History and Current Medications.--The
Secretary shall implement a process to ensure that, if care of a
veteran by a covered health care provider is authorized under the laws
administered by the Secretary, the document authorizing such care
includes the relevant medical history of the veteran and a list of all
medications prescribed to the veteran.
(c) Submittal of Prescriptions.--
(1) In general.--Except as provided in paragraph (3), the
Secretary shall require, to the maximum extent practicable,
each covered health care provider to submit prescriptions for
opioids--
(A) to the Department for prior authorization for
the prescribing of a limited amount of opioids under
contracts the Department has with retail pharmacies; or
(B) directly to a pharmacy of the Department for
the dispensing of such prescription.
(2) Department responsibility.--In carrying out paragraph
(1), upon receipt by the Department of a prescription for
opioids for a veteran under the laws administered by the
Secretary, the Secretary shall--
(A) record such prescription in the electronic
health record of the veteran; and
(B) monitor such prescription as outlined in the
Opioid Safety Initiative of the Department.
(3) Exception.--
(A) In general.--A covered health care provider is
not required under paragraph (1)(B) to submit an opioid
prescription directly to a pharmacy of the Department
if--
(i) the health care provider determines
that there is an immediate medical need for the
prescription, including an urgent or emergent
prescription or a prescription dispensed as
part of an opioid treatment program that
provides office-based medications; and
(ii)(I) following an inquiry into the
matter, a pharmacy of the Department notifies
the health care provider that it cannot fill
the prescription in a timely manner; or
(II) the health care provider determines
that the requirement under paragraph (1)(B)
would impose an undue hardship on the veteran,
including with respect to travel distances, as
determined by the Secretary.
(B) Notification to department.--If a covered
health care provider uses an exception under
subparagraph (A) with respect to an opioid prescription
for a veteran, the health care provider shall, on the
same day the prescription is written, submit to the
Secretary for inclusion in the electronic health record
of the veteran a notice, in such form as the Secretary
may establish, providing information about the
prescription and describing the reason for the
exception.
(C) Report.--
(i) In general.--Not less frequently than
quarterly, 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 evaluating
the compliance of covered health care providers
with the requirements under this paragraph and
setting forth data on the use by health care
providers of exceptions under subparagraph (A)
and notices under subparagraph (B).
(ii) Elements.--Each report required by
clause (i) shall include the following with
respect to the quarter covered by the report:
(I) The number of exceptions used
under subparagraph (A) and notices
received under subparagraph (B).
(II) The rate of compliance by the
Department with the requirement under
subparagraph (B) to include such
notices in the health records of
veterans.
(III) The identification of any
covered health care providers that,
based on criteria prescribed the
Secretary, are determined by the
Secretary to be statistical outliers
regarding the use of exceptions under
subparagraph (A).
(d) Use of Opioid Safety Initiative Guidelines.--
(1) In general.--If a director of a medical center of the
Department or a Veterans Integrated Service Network determines
that the opioid prescribing practices of a covered health care
provider conflicts with or is otherwise inconsistent with the
standards of appropriate and safe care, as that term is used in
section 913(d) of the Jason Simcakoski Memorial and Promise Act
(Public Law 114-198; 38 U.S.C. 1701 note), the director shall
take such action as the director considers appropriate to
ensure the safety of all veterans receiving care from that
health care provider, including removing or directing the
removal of any such health care provider from provider networks
or otherwise refusing to authorize care of veterans by such
health care provider in any program authorized under the laws
administered by the Secretary.
(2) Inclusion in contracts.--The Secretary shall ensure
that any contracts entered into by the Secretary with third
parties involved in administering programs that provide care in
the community to veterans under the laws administered by the
Secretary specifically grant the authority set forth in
paragraph (1) to such third parties and to the directors
described in that paragraph, as the case may be.
(e) Denial or Revocation of Eligibility of Non-Department
Providers.--The Secretary shall deny or revoke the eligibility of a
non-Department health care provider to provide health care to veterans
under the laws administered by the Secretary if the Secretary
determines that the opioid prescribing practices of the provider--
(1) violate the requirements of a medical license of the
health care provider; or
(2) detract from the ability of the health care provider to
deliver safe and appropriate health care.
(f) Covered Health Care Provider Defined.--In this section, the
term ``covered health care provider'' means a non-Department of
Veterans Affairs health care provider who provides health care to
veterans under the laws administered by the Secretary of Veterans
Affairs.
Subtitle C--Improving Collections
SEC. 221. ALIGNING WITH BEST PRACTICES ON COLLECTION OF HEALTH
INSURANCE INFORMATION.
Section 1705A is amended--
(1) in subsection (a)(1), by striking ``Any individual''
and all that follows through ``covered.'' and inserting the
following: ``Any individual who applies for or seeks hospital
care or medical services under this chapter shall, at the time
of such application, or otherwise when requested by the
Secretary, furnish the Secretary with such current information
as the Secretary may require to identify any health-plan
contract, as defined in subsection (i)(l) of section 1729,
under which such individual is covered, to include, as
applicable, the name, address, and telephone number of such
health-plan contract; the name of the policy holder, if
coverage under a health-plan contract is in the name of a
person other than such individual; the plan identification
number; and the group code of the plans.''; and
(2) in subsection (c)--
(A) by striking ``The Secretary'' and inserting
``(1) Except as provided in paragraph (2), the
Secretary''; and
(B) by adding at the end the following new
paragraph:
``(2) The Secretary may charge an individual who does not provide
the information required by subsection (a) reasonable charges for the
provision of such care and services.''.
SEC. 222. IMPROVING AUTHORITY TO COLLECT.
(a) Broadening Scope of Applicability.--Section 1729 is amended--
(1) in subsection (a)--
(A) in paragraph (2)(A)--
(i) by striking ``the veteran's'' and
inserting ``the individual's''; and
(ii) by striking ``the veteran'' and
inserting ``the individual''; and
(B) in paragraph (3)--
(i) in the matter preceding subparagraph
(A), by striking ``the veteran'' and inserting
``the individual''; and
(ii) in subparagraph (A), by striking ``the
veteran's'' and inserting ``the individual's'';
(2) in subsection (b)--
(A) in paragraph (1)--
(i) by striking ``the veteran'' and
inserting ``the individual''; and
(ii) by striking ``the veteran's'' and
inserting ``the individual's''; and
(B) in paragraph (2)--
(i) in subparagraph (A)--
(I) by striking ``the veteran'' and
inserting ``the individual''; and
(II) by striking ``the veteran's''
and inserting ``the individual's''; and
(ii) in subparagraph (B)--
(I) in clause (i), by striking
``the veteran'' and inserting ``the
individual''; and
(II) in clause (ii)--
(aa) by striking ``the
veteran'' and inserting ``the
individual''; and
(bb) by striking ``the
veteran's'' each place it
appears and inserting ``the
individual's'';
(3) in subsection (e), by striking ``A veteran'' and
inserting ``An individual''; and
(4) in subsection (h)--
(A) in paragraph (1)--
(i) in the matter preceding subparagraph
(A), by striking ``a veteran'' and inserting
``an individual'';
(ii) in subparagraph (A), by striking ``the
veteran'' and inserting ``the individual''; and
(iii) in subparagraph (B), by striking
``the veteran'' and inserting ``the
individual''; and
(B) in paragraph (2)--
(i) by striking ``A veteran'' and inserting
``An individual'';
(ii) by striking ``a veteran'' and
inserting ``an individual''; and
(iii) by striking ``the veteran'' and
inserting ``the individual''.
(b) Additional Amendments.--Such section is further amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``(1) Subject''
and all that follows through the period and inserting
the following: ``(1) Subject to the provisions of this
section, in any case in which the United States is
required by law to furnish or pay for care or services
under this chapter for a non-service-connected
disability described in paragraph (2) of this
subsection, the United States has the right to recover
or collect from a third party the reasonable charges of
care or services so furnished or paid for to the extent
that the recipient or 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 or paid for by a department or
agency of the United States.'';
(B) in paragraph (2)--
(i) in subparagraph (C), by striking the
semicolon and inserting ``; or'';
(ii) by amending subparagraph (D) to read
as follows:
``(D) that is incurred by an individual who is entitled to
care (or payment of the expenses of care) under a health-plan
contract.''; and
(iii) by striking subparagraph (E); and
(C) by adding at the end the following new
paragraph:
``(4) In the case of a health-plan contract where the United States
has a right to recover or collect reasonable charges, the Secretary
shall collect from a veteran or responsible individual any copayment or
cost-share required under this chapter.'';
(2) in subsection (b), by adding at the end the following
new paragraph:
``(3)(A) The obligation of the third party to pay is not dependent
upon an individual executing an assignment of benefits to the United
States, nor is the obligation to pay dependent upon any other
submission by the beneficiary to the third party, including any claim
or appeal.
``(B) In any case in which the Secretary makes a claim, appeal,
representation, or other filing under the authority of this chapter,
any procedural requirement in any third-party plan for the beneficiary
of such plan to make the claim, appeal, representation, or other filing
is deemed to be satisfied.''; and
(3) in subsection (f)--
(A) by inserting ``(1)'' before ``No law''; and
(B) by adding at the end the following new
paragraph:
``(2) The absence of a participating provider agreement, Veterans
Care Agreement, or other contractual arrangement with a third party
described in subsection (i)(3)(D) shall not operate to prevent, or
reduce the amount of, any such recovery or collection by the United
States. For purposes of this section, the Department shall recover or
collect as if it were a participating provider.''; and
(c) Definitions.--Subsection (i) of such section is amended to read
as follows:
``(i) In this section:
``(1) The term `health-plan contract' includes any of the
following:
``(A) An insurance policy or contract including any
health maintenance organization, preferred provider
organization, point of service organization,
accountable care organization, or any other type of
health insurance policy or contract, medical or
hospital service agreement, membership or subscription
contract, or similar arrangement under which hospital
care or medical services for individuals are provided
or the expenses of such services are paid.
``(B) A workers' compensation law or plan.
``(2) The term `payment' includes reimbursement and
indemnification.
``(3) The term `third party' means any of the following:
``(A) A State or political subdivision of a State.
``(B) An employer or an employer's insurance
carrier.
``(C) An automobile accident reparations or
liability insurance carrier.
``(D) A person or entity obligated to provide, or
to pay the expenses of, health services under a health-
plan contract.
``(4) The term `reasonable charges' shall include the
following:
``(A) For hospital care or medical services
furnished by the Department, charges established in
accordance with this section.
``(B) For hospital care or medical services paid
for under subparagraphs (A) and (B) of subsection
(a)(2), the amount paid to a non-Department entity or
provider.''.
TITLE III--IMPROVING DEPARTMENT OF VETERANS AFFAIRS CARE DELIVERY
Subtitle A--Improving Personnel Practices
SEC. 301. LICENSURE OF HEALTH CARE PROFESSIONALS OF THE DEPARTMENT OF
VETERANS AFFAIRS PROVIDING TREATMENT VIA TELEMEDICINE.
(a) In General.--Chapter 17, as amended by section 102, is further
amended by adding at the end the following new section:
``Sec. 1730C. Licensure of health care professionals providing
treatment via telemedicine
``(a) In General.--Notwithstanding any provision of law regarding
the licensure of health care professionals, a covered health care
professional may practice the health care profession of the health care
professional at any location in any State, regardless of where in a
State the covered health care professional or the patient is located,
if the covered health care professional is using telemedicine to
provide treatment to an individual under this chapter.
``(b) Covered Health Care Professionals.--For purposes of this
section, a covered health care professional is any health care
professional who--
``(1) is an employee of the Department appointed under this
title or title 5;
``(2) is authorized by the Secretary to provide health care
under this chapter;
``(3) is required to adhere to all standards for quality
relating to the provision of medicine in accordance with
applicable policies of the Department; and
``(4) has an active, current, full, and unrestricted
license, registration, or certification in a State to practice
the health care profession of the health care professional.
``(c) Property of Federal Government.--Subsection (a) shall apply
to a covered health care professional providing treatment to a patient
regardless of whether the covered health care professional or patient
is located in a facility owned by the Federal Government during such
treatment.
``(d) Relation to State Law.--(1) The provisions of this section
shall supersede any provisions of the law of any State to the extent
that such provision of State law are inconsistent with this section.
``(2) No State shall deny or revoke the license, registration, or
certification of a covered health care professional who otherwise meets
the qualifications of the State for holding the license, registration,
or certification on the basis that the covered health care professional
has engaged or intends to engage in activity covered by subsection (a).
``(e) Rule of Construction.--Nothing in this section may be
construed to remove, limit, or otherwise affect any obligation of a
covered health care professional under the Controlled Substances Act
(21 U.S.C. 801 et seq.).''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1730B, as added by section 102, the following new
item:
``1730C. Licensure of health care professionals providing treatment via
telemedicine.''.
(c) Report on Telemedicine.--
(1) In general.--Not later than one year after the earlier
of the date on which services provided under section 1730C of
title 38, United States Code, as added by subsection (a), first
occur or regulations are promulgated to carry out such section,
the Secretary of Veterans Affairs 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 effectiveness of the use of telemedicine by the Department
of Veterans Affairs.
(2) Elements.--The report required by paragraph (1) shall
include an assessment of the following:
(A) The satisfaction of veterans with telemedicine
furnished by the Department.
(B) The satisfaction of health care providers in
providing telemedicine furnished by the Department.
(C) The effect of telemedicine furnished by the
Department on the following:
(i) The ability of veterans to access
health care, whether from the Department or
from non-Department health care providers.
(ii) The frequency of use by veterans of
telemedicine.
(iii) The productivity of health care
providers.
(iv) Wait times for an appointment for the
receipt of health care from the Department.
(v) The use by veterans of in-person
services at Department facilities and non-
Department facilities.
(D) The types of appointments for the receipt of
telemedicine furnished by the Department that were
provided during the one-year period preceding the
submittal of the report.
(E) The number of appointments for the receipt of
telemedicine furnished by the Department that were
requested during such period, disaggregated by medical
facility.
(F) Savings by the Department, if any, including
travel costs, from furnishing health care through the
use of telemedicine during such period.
SEC. 302. GRADUATE MEDICAL EDUCATION AND RESIDENCY.
(a) Increase in Number of Graduate Medical Education Residency
Positions.--
(1) In general.--The Secretary of Veterans Affairs shall
increase the number of graduate medical education residency
positions at covered facilities by not fewer than 1,500
positions in the 10-year period beginning on the date of the
enactment of this Act.
(2) Covered facilities.--For purposes of this section, a
covered facility is any of the following:
(A) A facility of the Department of Veterans
Affairs.
(B) A facility operated by an Indian tribe or a
tribal organization, as those terms are defined in
section 4 of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 5304).
(C) A facility operated by the Indian Health
Service.
(D) A 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)).
(E) A community health center.
(F) A facility operated by the Department of
Defense.
(G) Such other health care facility as the
Secretary considers appropriate for purposes of this
section.
(3) Stipends and benefits.--The Secretary may pay stipends
and provide benefits for residents in positions under paragraph
(1), regardless of whether they have been assigned in a
Department facility.
(4) Parameters for location, affiliate sponsor, and
duration.--When determining characteristics of residency
positions under paragraph (1), the Secretary shall consider the
extent to which there is a clinical need for providers, as
determined by the market area assessment most recently
performed under section 1730B(c) of title 38, United States
Code, as added by section 102.
(5) Parameters for types of specialties.--When determining
the types of specialties to be included in residency positions
under paragraph (1), the Secretary shall consider the
following:
(A) The types of specialties that improve the
quality and coverage of medical services provided to
veterans.
(B) The range of clinical specialties covered by
providers in standardized geographic areas surrounding
facilities.
(C) Whether the specialty is included in the most
recent staffing shortage determination of the
Department under section 7412 of title 38, United
States Code.
(D) The most recent market area assessment
performed under section 1730B(c) of title 38, United
States Code, as added by section 102.
(b) Application To Participate.--To participate as a resident in
one of the positions increased under subsection (a)(1), an individual
shall submit to the Secretary an application therefor together with an
agreement described in subsection (d) under which the participant
agrees to serve a period of obligated service in the Veterans Health
Administration as provided in the agreement in return for payment of
stipend and benefit support as provided in the agreement.
(c) Selection.--
(1) In general.--An individual becomes a participant in a
residency program under this section upon the Secretary's
approval of the individual's application under subsection (b)
and the Secretary's acceptance of the agreement under
subsection (d) (if required).
(2) Notice.--Upon the Secretary's approval of an
individual's participation in the program under paragraph (1),
the Secretary shall promptly notify the individual of that
approval. Such notice shall be in writing.
(d) Agreement.--
(1) In general.--An agreement between the Secretary and a
resident in a position under subsection (a)(1) shall be in
writing and shall be signed by the resident containing such
terms as the Secretary may specify.
(2) Requirements.--The agreement must specify the terms of
the service obligation resulting from participating as a
resident under this section, including by requiring a service
obligation equal to the number of years of stipend and benefit
support.
(e) Conditions of Employment.--The Secretary may prescribe the
conditions of employment of persons appointed to positions under
subsection (a)(1), including necessary training, and the customary
amount and terms of pay for such positions during the period of such
employment and training.
(f) Obligated Service.--
(1) In general.--Each person appointed to a position under
subsection (a)(1) shall provide service as a full-time employee
of the Department for the period of obligated service provided
in the agreement of the participant entered into under
subsection (d). Such service shall be provided in the full-time
clinical practice of such participant's profession or in
another health-care position in an assignment or location
determined by the Secretary.
(2) Commencement date.--Not later than 60 days before the
date on which a person commences serving in a position under
subsection (a)(1), the Secretary shall notify the person of
such date. Such date shall be the first day of the person's
period of obligated service.
(g) Breach of Agreement: Liability.--
(1) Penalty.--A person appointed under this section to a
position under subsection (a)(1) (other than a person who is
liable under paragraph (2)) who fails to accept payment, or
instructs the educational institution in which the person is
enrolled not to accept payment, in whole or in part, for a
residency under the agreement entered into under subsection (d)
of this title shall be liable to the United States for
liquidated damages in the amount of $1,500. Such liability is
in addition to any period of obligated service or other
obligation or liability under the agreement.
(2) Liability.--
(A) In general.--A person appointed to a position
under subsection (a)(1) shall be liable to the United
States for the amount which has been paid to or on
behalf of the person under the agreement if any of the
following occurs:
(i) The person is dismissed from the
position for disciplinary reasons.
(ii) The person voluntarily terminates the
residency before the completion of such course
of training.
(iii) The person loses the person's
license, registration, or certification to
practice the person's health care profession in
a State.
(B) Liability supplants service obligation.--
Liability under this paragraph is in lieu of any
service obligation arising under the person's agreement
under subsection (d).
(h) Recovery.--
(1) In general.--If a person breaches the person's
agreement under subsection (d) by failing (for any reason) to
complete such person's period of obligated service, the United
States shall be entitled to recover from the person an amount
equal to the product of--
(A) three;
(B) the sum of--
(i) the amounts paid under this section to
or on behalf of the person; and
(ii) the interest on such amounts that
would be payable if at the time the amounts
were paid they were loans bearing interest at
the maximum legal prevailing rate, as
determined by the Treasurer of the United
States; and
(C) the quotient of--
(i) the difference between--
(I) the total number of months in
the person's period of obligated
service; and
(II) the number of months of such
period served by the person; and
(ii) the total number of months in the
person's period of obligated service.
(2) Period of recovery.--Any amount which the United States
is entitled to recover under this subsection shall be paid to
the United States not later than the date that is one year
after the date of the breach of the agreement.
(i) Annual Report.--
(1) In general.--Not later than one year after the date of
the enactment of this Act and not less frequently than once
each year thereafter, the Secretary shall submit to the
appropriate committees of Congress a report on the
implementation of this section during the previous year.
(2) Contents.--Each report submitted under paragraph (1)
shall include, for the period covered by the report, the
following:
(A) The number of positions described in subsection
(a) that were filled.
(B) The location of each such position.
(C) The academic affiliate associated with each
such position.
(D) A description of the challenges faced in
filling the positions described in subsection (a) and
the actions the Secretary has taken to address such
challenges.
(3) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
SEC. 303. ANNUAL REPORT ON AWARDS OR BONUSES AWARDED TO CERTAIN HIGH-
LEVEL EMPLOYEES OF THE DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--Chapter 7 is amended by adding at the end the
following new section:
``Sec. 726. Annual report on awards to certain high-level employees
``(a) In General.--Not later than 30 days after the end of each
fiscal year, the Secretary shall submit to the appropriate committees
of Congress a report that contains, for the most recent fiscal year
ending before the submittal of the report, a description of the
performance awards and bonuses awarded to Regional Office Directors of
the Department, Directors of Medical Centers of the Department, and
Directors of Veterans Integrated Service Networks.
``(b) Elements.--Each report submitted under subsection (a) shall
include the following with respect to each award or bonus awarded to an
individual described in such subsection:
``(1) The type of award or bonus, specifically those
awarded for performance or on the basis of recruitment,
relocation and retention as the case may be.
``(2) The amount of each award or bonus.
``(3) The job title of the individual awarded the award or
bonus.
``(4) The location where the individual awarded the award
or bonus works.
``(c) Appropriate Committees of Congress.--In this section, the
term `appropriate committees of Congress' means--
``(1) the Committee on Veterans' Affairs and the Committee
on Appropriations of the Senate; and
``(2) the Committee on Veterans' Affairs and the Committee
on Appropriations of the House of Representatives.''.
(b) Clerical Amendment.--The table of sections at the beginning of
chapter 7 of such title is amended by inserting after the item relating
to section 725 the following new item:
``726. Annual report on awards to certain high-level employees.''.
Subtitle B--Facilities, Construction, and Leases
SEC. 311. FACILITATING SHARING OF MEDICAL FACILITIES WITH OTHER FEDERAL
AGENCIES.
(a) Construction or Lease of Shared Facility.--
(1) In general.--Subchapter I of chapter 81 is amended by
inserting after section 8111A the following new section:
``Sec. 8111B. Authority to plan, design, construct, or lease a shared
medical facility
``(a) In General.--(1) The Secretary may enter into agreements with
other Federal agencies for the planning, designing, constructing, or
leasing shared medical facilities with the goal of improving access to,
and quality and cost effectiveness of, health care provided by the
Department and other Federal agencies.
``(2) Facilities planned, designed, constructed, or leased under
paragraph (1) shall be managed by the Director of the High-Performing
Integrated Healthcare Network of the Department designated under
section 1730B(a) of this title.
``(b) Transfer of Amounts to Other Federal Agencies.--(1) The
Secretary may transfer to another Federal agency amounts appropriated
to the Department for `Construction, Minor Projects' for use for the
planning, design, or construction of a shared medical facility if the
estimated share of the project costs to be borne by the Department does
not exceed the threshold for a major medical facility construction
project under section 8104(a)(3)(A) of this title.
``(2) The Secretary may transfer to another Federal agency amounts
appropriated to the Department for `Construction, Major Projects' for
use for the planning, design, or construction of a shared medical
facility if--
``(A) the estimated share of the project costs to be borne
by the Department is more than the threshold for a major
medical facility construction project under subsection
(a)(3)(A) of section 8104 of this title; and
``(B) the requirements for such a project under such
section have been met.
``(3) The Secretary may transfer to another Federal agency amounts
appropriated to the applicable appropriations account of the Department
for the purpose of leasing space for a shared medical facility if the
estimated share of the lease costs to be borne by the Department does
not exceed the threshold for a major medical facility lease under
section 8104(a)(3)(B) of this title.
``(c) Transfer of Amounts to Department.--(1) Amounts transferred
to the Department by another Federal agency for the necessary expenses
of planning, designing, or constructing a shared medical facility for
which the estimated share of the project costs to be borne by the
Department does not exceed the threshold for a major medical facility
project under section 8104(a)(3)(A) of this title may be deposited in
the `Construction, Minor Projects' account of the Department and used
for such necessary expenses.
``(2) Amounts transferred to the Department by another Federal
agency for the necessary expenses of planning, designing, or
constructing a shared medical facility for which the estimated share of
the project costs to be borne by the Department is more than the
threshold for a major medical facility project under section
8104(a)(3)(A) of this title may be deposited in the `Construction,
Major Projects' account of the Department and used for such necessary
expenses if the requirements for such project under section 8104 of
this title have been met.
``(3) Amounts transferred to the Department by another Federal
agency for the purpose of leasing space for a shared medical facility
may be credited to the applicable appropriations account of the
Department and shall be available without fiscal year limitation.
``(4) Amounts transferred under paragraphs (1) and (2) shall be
available for the same time period as amounts in the account to which
those amounts are transferred.''.
(2) Clerical amendment.--The table of sections at the
beginning of such chapter is amended by inserting after the
item relating to section 8111A the following new item:
``8111B. Authority to plan, design, construct, or lease a shared
medical facility.''
(b) Modification of Definition of Medical Facility.--Paragraph (3)
of section 8101 is amended to read as follows:
``(3) The term `medical facility' means any facility or
part thereof that is, or will be, under the jurisdiction of the
Secretary, or as otherwise designated by law, for the provision
of healthcare services (including hospital care, outpatient
care, nursing home care, domiciliary care, or medical
services), including any necessary building and auxiliary
structure, garage, parking facility, mechanical equipment,
trackage facilities leading thereto, abutting sidewalks,
accommodations for attending personnel, and recreation
facilities associated therewith.''.
SEC. 312. REVIEW OF ENHANCED USE LEASES.
Section 8162 is amended--
(1) in subsection (a), by amending paragraph (2) to read as
follows:
``(2) With respect to enhanced-use leases entered into on or after
the date of enactment of the Veterans Community Care and Access Act of
2017, the Secretary may enter into an enhanced-use lease only if the
Secretary determines that--
``(A) the lease will not be inconsistent with and will not
adversely affect the mission of the Department; and
``(B)(i) the lease will enhance the use of the property; or
``(ii) the leased property will provide supportive housing
as defined in section 8161 of this title.''; and
(2) in subsection (b), by amending paragraph (6) to read as
follows:
``(6) The Director of the Office of Management and Budget shall
review each such enhanced-use lease prior to execution for compliance
with paragraph (5) of this subsection.''.
TITLE IV--INNOVATIVE PILOT PROGRAMS
SEC. 401. PILOT PROGRAM TO ESTABLISH OR AFFILIATE WITH GRADUATE MEDICAL
RESIDENCY PROGRAMS AT FACILITIES OPERATED BY INDIAN
TRIBES, TRIBAL ORGANIZATIONS, AND THE INDIAN HEALTH
SERVICE IN RURAL AREAS.
(a) Pilot Program Required.--The Secretary of Veterans Affairs, in
consultation with the Director of the Indian Health Service, shall
carry out a pilot program--
(1) to establish graduate medical education residency
training programs at covered facilities; or
(2) to affiliate with established programs described in
paragraph (1).
(b) Covered Facilities.--For purposes of the pilot program, a
covered facility is any facility--
(1) described in subparagraph (B) or (C) of section
302(a)(2); and
(2) located in a rural or remote area, as determined by the
Secretary and the Director of the Indian Health Service.
(c) Locations.--
(1) In general.--The Secretary shall carry out the pilot
program at not more than five covered facilities that have been
selected by the Secretary for purposes of the pilot program.
(2) Criteria.--The Secretary shall establish criteria for
selecting covered facilities under paragraph (1).
(d) Duration.--The Secretary shall carry out the pilot program
during the eight-year period beginning on the date that is 180 days
after the date of the enactment of this Act.
(e) Reimbursement of Costs.--The Secretary shall reimburse each
covered facility participating in the pilot program for the following
costs associated with the pilot program:
(1) Curriculum development.
(2) Recruitment, training, supervision, and retention of
residents and faculty.
(3) Accreditation of programs of education under the pilot
program by the Accreditation Council for Graduate Medical
Education (ACGME) or the American Osteopathic Association
(AOA).
(4) The portion of faculty salaries attributable to
activities relating to carrying out the pilot program.
(5) Payment for expenses relating to providing medical
education under the pilot program.
(6) Stipends and benefits.
(f) Period of Obligated Service.--
(1) In general.--The Secretary shall enter into an
agreement with each individual who participates in the pilot
program under which such individual agrees to serve under the
same terms as established under section 302.
(2) Loan repayment.--During the period of obligated service
of an individual under paragraph (1), the individual--
(A) shall be deemed to be an eligible individual
under subsection (b) of section 108 of the Indian
Health Care Improvement Act (25 U.S.C. 1616a) for
purposes of participation in the Indian Health Service
Loan Repayment Program under such section during the
portion of such period that the individual serves at a
covered facility; and
(B) shall be deemed to be an eligible individual
under section 7682(a) of title 38, United States Code,
for purposes of participation in the Department of
Veterans Affairs Education Debt Reduction Program under
subchapter VII of chapter 76 of such title during the
portion of such period that the individual serves at a
facility of the Department.
(3) Concurrent service.--Any period of obligated service
required of an individual under paragraph (1) shall be served--
(A) with respect to service at a covered facility,
concurrently with any period of obligated service
required of the individual by the Indian Health
Service; and
(B) with respect to service at a facility of the
Department of Veterans Affairs, concurrently with any
period of obligated service required of the individual
by the Department.
(g) Treatment of Participants.--A residency position into which a
participant in the pilot program is placed as part of the pilot program
shall be considered a position referred to in section 302(a)(1) for
purposes of the limitation on number of new positions authorized under
such section.
(h) Report.--Not later than three years before the date on which
the pilot program terminates, the Secretary of Veterans Affairs 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 feasibility and advisability of--
(1) expanding the pilot program to additional locations;
and
(2) making the pilot program or any aspect of the pilot
program permanent.
SEC. 402. AUTHORITY FOR DEPARTMENT OF VETERANS AFFAIRS CENTER FOR
INNOVATION FOR CARE AND PAYMENT.
(a) In General.--Subchapter I of chapter 17, as amended by section
122, is further amended by inserting after section 1703E, as added by
section 122, the following new section:
``Sec. 1703F. Center for Innovation for Care and Payment
``(a) In General.--(1) There is established within the Department a
Center for Innovation for Care and Payment (in this section referred to
as the `Center').
``(2) The Secretary, acting through the Center, may carry out such
pilot programs as appropriate to develop new, innovative approaches to
testing payment and service delivery models to reduce expenditures
while preserving or enhancing the quality of care furnished by the
Department.
``(3) The Secretary, acting through the Center, shall test payment
and service delivery models to determine whether such models improve
the access to and quality, timeliness, and patient satisfaction of such
care and services, as well as the cost savings associated with such
models.
``(4)(A) The Secretary shall test models where the Secretary
determines that there is evidence that the model addresses a defined
population for which there are deficits care leading to poor clinical
outcomes or potentially avoidable expenditures.
``(B) The Secretary shall focus on models expected to reduce
program costs while preserving or enhancing the quality of care
received by individuals receiving benefits under this chapter.
``(C) The models selected may include those described in section
1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).
``(5) In selecting models for testing, the Secretary may consider
the following additional factors:
``(A) Whether the model includes a regular process for
monitoring and updating patient care plans in a manner that is
consistent with the needs and preferences of applicable
individuals.
``(B) Whether the model places the applicable individual,
including family members and other caregivers of the applicable
individual, at the center of the care team of the applicable
individual.
``(C) Whether the model uses technology or new systems to
coordinate care over time and across settings.
``(D) Whether the model demonstrates effective linkage with
other public sector payers, private sector payers, or statewide
payment models.
``(6)(A) Models tested under this section may not be designed in
such a way that would allow the United States to recover or collect
reasonable charges from a Federal health care program for care or
services furnished by the Secretary to veterans under pilot programs
carried out under this section.
``(B) In this paragraph, the term `Federal health care program'
means--
``(i) an insurance program described in section 1811 of the
Social Security Act (42 U.S.C. 1395c) or established by section
1831 of such Act (42 U.S.C. 1395j); or
``(ii) a State plan for medical assistance approved under
title XIX of such Act (42 U.S.C. 1396 et seq.); or
``(iii) a TRICARE program operated under sections 1075,
1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.
``(b) Duration.--Pilot programs carried out by the Secretary under
this section shall terminate no later than five years after their
commencement.
``(c) Location.--The Secretary shall ensure that pilot programs
carried out under this section occur in different areas that are
appropriate for the intended purposes of the pilot program.
``(d) Budget.--Funding for pilot programs carried out by the
Secretary under this section will be derived from appropriations
provided in advance in appropriations Acts for the Veterans Health
Administration and from appropriations provided for information
technology systems.
``(e) Notice.--The Secretary shall publish information about such
pilot programs in the Federal Register, and shall take reasonable
actions to provide direct notice to veterans eligible to participate in
a pilot program operated under this section.
``(f) Waiver of Authorities.--(1) Subject to reporting under
paragraph (2) and approval under paragraph (3), in implementing the
pilot programs under this section, the Secretary may waive such
requirements in subchapters I, II, and III of this chapter as may be
necessary solely for the purposes of carrying out this section with
respect to testing models described in subsection (a).
``(2) Before waiving any authority under paragraph (1), the
Secretary shall submit a report to the Speaker of the House of
Representatives, the minority leader of the House of Representatives,
the majority leader of the Senate, the minority leader of the Senate,
and each standing committee with jurisdiction under the rules of the
Senate of the House of Representatives to report a bill to amend the
provision or provisions of law that would be waived by the Department
describing in detail the following:
``(A) The specific authorities to be waived under the pilot
program.
``(B) The standard or standards to be used in the pilot
program in lieu of the waived authorities.
``(C) The reasons for such waiver or waivers.
``(D) A description of the metric or metrics the Secretary
will use to determine the effect of the waiver or waivers upon
the access to and quality, timeliness, or patient satisfaction
of care and services furnished through the pilot program.
``(E) The anticipated cost savings, if any, of the pilot
program.
``(F) The schedule for interim reports on the pilot program
describing the results of the pilot program so far and the
feasibility and advisability of continuing the pilot program.
``(G) The schedule for the termination of the pilot program
and the submission of a final report on the pilot program
describing the result of the pilot program and the feasibility
and advisability of making the pilot program permanent.
``(H) The estimated budget of the pilot program.
``(3)(A) Upon receipt of a report submitted under paragraph (2),
each House shall provide copies of the report to the chairman and
ranking member of each standing committee with jurisdiction under the
rules of the House of Representatives or the Senate to report a bill to
amend the provision or provisions of law that would be waived by the
Department under this subsection.
``(B)(i) The waiver requested by the Secretary under paragraph (2)
shall be considered approved under this paragraph if there is enacted
into law a bill or joint resolution approving such request in its
entirety. Such bill or joint resolution shall be passed by recorded
vote to reflect the vote of each member of Congress thereon.
``(ii) The provisions of this paragraph are enacted by the
Congress--
``(I) as an exercise of the rulemaking power of the Senate
and the House of Representatives and as such shall be
considered as part of the rules of each House, and shall
supersede other rules only to the extent that they are
inconsistent therewith; and
``(II) with full recognition of the constitutional right of
either House to change the rules (so far as they relate to the
procedures of that House) at any time, in the same manner, and
to the same extent as in the case of any other rule of that
House.
``(C) During the 60-calendar-day period beginning on the date on
which the Secretary submits the report described in paragraph (2) to
Congress, it shall be in order as a matter of highest privilege in each
House of Congress to consider a bill or joint resolution, if offered by
the majority leader of such House (or a designee), approving such
request in its entirety.
``(g) Limitations.--(1) The waiver provisions in subsection (f)
shall not be available unless the Secretary submits the first proposal,
in accordance with the requirements in subsection (f), for a pilot
program within 18 months of the date of the enactment of the Veterans
Community Care and Access Act of 2017.
``(2) Notwithstanding section 502 of this title, decisions by the
Secretary under this section shall, consistent with section 511 of this
title, be final and conclusive and may not be reviewed by any other
official or by any court, whether by an action in the nature of
mandamus or otherwise.
``(3)(A) If the Secretary determines that the pilot program is not
improving the quality of care or producing cost savings, the Secretary
shall--
``(i) propose a modification to the pilot program in the
interim report that shall also be considered a report under
subsection (f)(2)(A) and shall be subject to the terms and
conditions of subsection (f)(2); or
``(ii) terminate such pilot program within 30 days of
submitting the interim report to Congress.
``(B) If the Secretary terminates the pilot program under
subparagraph (A)(ii), for purposes of clauses (vi) and (vii) of
subsection (f)(2)(A), such interim report will also serve as the final
report for that pilot program.
``(h) Evaluation and Reporting Requirements.--(1) The Secretary
shall conduct an evaluation of each model tested, which shall include,
at a minimum, an analysis of--
``(A) the quality of care furnished under the model,
including the measurement of patient-level outcomes and
patient-centeredness criteria determined appropriate by the
Secretary; and
``(B) the changes in spending by reason of that model.
``(2) The Secretary shall make the results of each evaluation under
this subsection available to the public in a timely fashion and may
establish requirements for other entities participating in the testing
of models under this section to collect and report information that the
Secretary determines is necessary to monitor and evaluate such models.
``(i) Coordination and Consultation.--(1) The Secretary shall
obtain advice from the Under Secretary for Health and the Special
Medical Advisory Group established pursuant to section 7312 of this
title in the development and implementation of any pilot program
operated under this section.
``(2) In carrying out the duties under this section, the Secretary
shall consult representatives of relevant Federal agencies, and
clinical and analytical experts with expertise in medicine and health
care management. The Secretary shall use appropriate mechanisms to seek
input from interested parties.
``(j) Expansion of Successful Pilot Programs.--Taking into account
the evaluation under subsection (f), the Secretary may, through
rulemaking, expand (including implementation on a nationwide basis) the
duration and the scope of a model that is being tested under subsection
(a) to the extent determined appropriate by the Secretary, if--
``(1) the Secretary determines that such expansion is
expected to--
``(A) reduce spending without reducing the quality
of care; or
``(B) improve the quality of patient care without
increasing spending; and
``(2) the Secretary determines that such expansion would
not deny or limit the coverage or provision of benefits for
applicable individuals.''.
(b) Conforming Amendment.--The table of sections at the beginning
of such chapter, as amended by section 122, is further amended by
inserting after the item relating to section 1703E the following new
item:
``1703F. Center for Innovation for Care and Payment.''.
TITLE V--OTHER HEALTH CARE MATTERS
SEC. 501. AUTHORIZATION OF APPROPRIATIONS FOR HEALTH CARE FROM
DEPARTMENT OF VETERANS AFFAIRS.
(a) In General.--There is authorized to be appropriated to the
Secretary of Veterans Affairs such amounts as may be necessary to carry
out the purposes set forth in subsection (b).
(b) Use of Amounts.--The purposes set forth in this subsection are
as follows:
(1) To increase the access of veterans to care as follows:
(A) To hire primary care and specialty care
physicians for employment in the Department of Veterans
Affairs.
(B) To hire other medical staff, including the
following:
(i) Physicians.
(ii) Nurses.
(iii) Social workers.
(iv) Mental health professionals.
(v) Physician assistants.
(vi) Other health care professionals as the
Secretary considers appropriate.
(C) To carry out the following:
(i) Section 7412 of title 38, United States
Code.
(ii) Section 7302(e) of such title.
(iii) Subchapters II and VII of chapter 76
of such title.
(iv) Section 301(b)(2) of the Veterans
Access, Choice, and Accountability Act of 2014
(Public Law 113-146; 38 U.S.C. 7302 note).
(D) To pay for expenses, equipment, and other costs
associated with the hiring of primary care, specialty
care physicians, and other medical staff under
subparagraphs (A), (B), and (C).
(2) To improve the physical infrastructure of the
Department as follows:
(A) To maintain and operate hospitals, nursing
homes, domiciliary facilities, and other facilities of
the Veterans Health Administration.
(B) To enter into contracts or hire temporary
employees to repair, alter, or improve facilities under
the jurisdiction of the Department that are not
otherwise provided for under this paragraph.
(C) To carry out leases for facilities of the
Department.
(D) To carry out minor construction projects of the
Department.
(3) To carry out sections 303 and 401.
(c) Funding Plan and Report.--
(1) In general.--Not later than 180 days after the date on
which amounts are appropriated to the Department pursuant to
the authorization in subsection (a), the Secretary of Veterans
Affairs shall submit to the appropriate committees of Congress
a funding plan and report on how the Secretary intends to
obligate the amounts so appropriated and how it relates to the
quadrennial Veterans Health Administration review and strategic
plan under section 1730B(a) of title 38, United States Code, as
added by section 102.
(2) Appropriate committees of congress defined.--In this
subsection, the term ``appropriate committees of Congress''
means--
(A) the Committee on Veterans' Affairs and the
Committee on Appropriations of the Senate; and
(B) the Committee on Veterans' Affairs and the
Committee on Appropriations of the House of
Representatives.
SEC. 502. APPROPRIATION OF AMOUNTS FOR VETERANS CHOICE PROGRAM.
(a) In General.--There is authorized to be appropriated, and is
appropriated, to the Secretary of Veterans Affairs, out of any funds in
the Treasury not otherwise appropriated, $4,000,000,000 to be deposited
in the Veterans Choice Fund under section 802 of the Veterans Access,
Choice, and Accountability Act of 2014 (Public Law 113-146; 38 U.S.C.
1701 note).
(b) Availability.--The amount appropriated under subsection (a)
shall remain available until expended pursuant to section 802(c)(4) of
the Veterans Access, Choice, and Accountability Act of 2014 (Public Law
113-146; 38 U.S.C. 1701 note) as added by section 202.
SEC. 503. APPLICABILITY OF DIRECTIVE OF OFFICE OF FEDERAL CONTRACT
COMPLIANCE PROGRAMS.
(a) In General.--Directive 2014-01 of the Office of Federal
Contract Compliance Programs of the Department of Labor (effective as
of May 7, 2014) shall apply to any entity entering into an agreement
under section 1703A or section 1745 of title 38, United States Code, as
amended by sections 112 and 114, respectively, in the same manner as
such directive applies to subcontractors under the TRICARE program for
the duration of the moratorium provided under such directive.
(b) Applicability Period.--The directive described in subsection
(a), and the moratorium provided under such directive, shall not be
altered or rescinded before May 7, 2019.
(c) TRICARE Program Defined.--In this section, the term ``TRICARE
program'' has the meaning given that term in section 1072 of title 10,
United States Code.
SEC. 504. AMENDING STATUTORY REQUIREMENTS FOR THE POSITION OF THE CHIEF
OFFICER OF THE READJUSTMENT COUNSELING SERVICE.
Section 7309(b)(2) is amended--
(1) in subparagraph (B), by striking ``in the Readjustment
Counseling Service''; and
(2) in subparagraph (C), by striking ``in the Readjustment
Counseling Service''.
SEC. 505. AUTHORIZATION OF CERTAIN MAJOR MEDICAL FACILITY PROJECTS OF
THE DEPARTMENT OF VETERANS AFFAIRS.
(a) Authorization.--The Secretary of Veterans Affairs may carry out
the following major medical facility project, to be carried out in an
amount not to exceed the amount specified for that project: Realignment
of medical facilities in Livermore, California, in an amount not to
exceed $117,300,000.
(b) Authorization of Appropriations for Construction.--There is
authorized to be appropriated to the Secretary of Veterans Affairs for
fiscal year 2018 or the year in which funds are appropriated for the
Construction, Major Projects account, $117,300,000 for the project
authorized in subsection (a).
(c) Submittal of Information.--Not later than 90 days after the
date of the enactment of this Act, for the project authorized in
section (a), the Secretary of Veterans Affairs shall submit to the
Committee on Veterans' Affairs of the Senate and the Committee on
Veterans' Affairs of the House of Representatives the following
information:
(1) A line item accounting of expenditures relating to
construction management carried out by the Department of
Veterans Affairs for such project.
(2) The future amounts that are budgeted to be obligated
for construction management carried out by the Department for
such project.
(3) A justification for the expenditures described in
paragraph (1) and the future amounts described in paragraph
(2).
(4) Any agreement entered into by the Secretary regarding
the Army Corps of Engineers providing services relating to such
project, including reimbursement agreements and the costs to
the Department of Veterans Affairs for such services.
<all>
Introduced in Senate
Read twice and referred to the Committee on Veterans' Affairs.
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