114 S2646 IS: Veterans Choice Improvement Act of 2016
U.S. Senate
2016-03-07
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.Short title; table of contents
(a)
This Act may be cited as the Veterans Choice Improvement Act of 2016
. (b)The table of contents for this Act is as follows:Sec. 1. Short title; table of contents.
TITLE I—Veterans Choice Program
Sec. 101. Establishment of Veterans Choice Program.
Sec. 102. Funding for Veterans Choice Program.
Sec. 103. Payment of health care providers under Veterans Choice Program.
Sec. 104. Termination of certain provisions authorizing care to veterans through non-Department of
Veterans Affairs providers.
TITLE II—Health care administrative matters
Sec. 201. Authorization of agreements between the Department of Veterans Affairs and non-Department
providers.
Sec. 202. Reimbursement of certain entities for emergency medical transportation.
Sec. 203. Requirement that Department of Veterans Affairs collect health-plan contract information
from veterans.
Sec. 204. Requirement for advance appropriations for the Veterans Choice Program account of the
Department of Veterans Affairs.
Sec. 205. Reauthorization of pilot program of enhanced contract care authority for health care
needs of veterans.
TITLE III—Other veterans matters
Sec. 301. Timeframe for payment of disability compensation for victims of contaminated water at
Camp Lejeune, North Carolina, when the Secretary of Veterans Affairs
establishes a presumption of service connection.
<enum>I</enum><header>Veterans Choice Program</header>
<section id="idBBCA8899C35A43DEA9C21DA79CF70C2D"><enum>101.</enum><header>Establishment of Veterans Choice Program</header>
<subsection id="id0CB365329CC540539276BBF660D5293F"><enum>(a)</enum><header>Establishment of program</header>
<paragraph id="id34A965D2BED347DF9F5CBCC98347F73C"><enum>(1)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, is amended by inserting after <external-xref legal-doc="usc" parsable-cite="usc/38/1703">section 1703</external-xref> the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id5B3D764793AC4AB7BECB61025E9BE79D" style="USC">
<section id="id86957dccf04a46e8994db8cc7c4ca7d5"><enum>1703A.</enum><header>Veterans Choice Program</header>
<subsection id="id49bcae73cd0d42d4a0457867c530911d"><enum>(a)</enum><header>Program</header>
<paragraph id="idb89c4f43443847beb2999cf19390fd56"><enum>(1)</enum><header>Furnishing of care</header>
<subparagraph id="id0f6b51bfb1944f68bbdeb3204822f764"><enum>(A)</enum><header>In general</header><text>Hospital care and medical services under this chapter shall be furnished to an eligible veteran described in subsection (b), at the election of such veteran, through contracts authorized under subsection (d), or any other law administered by the Secretary, with entities specified in subparagraph (B) for the furnishing of such care and services to veterans. The furnishing of hospital care and medical services under this section may be referred to as the <quote>Veterans Choice Program</quote>.</text>
</subparagraph><subparagraph id="id333ee912232641fb84b46b4dbb47d88d"><enum>(B)</enum><header>Entities specified</header><text>The entities specified in this subparagraph are the following:</text> <clause id="id692112aa33a54bb688765402effd3d2b"><enum>(i)</enum><text>Any health care provider that is participating in the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>), including any physician furnishing services under such program.</text>
</clause><clause id="id02e153d56eb540f8a76c88d44282fba2"><enum>(ii)</enum><text>Any Federally-qualified health center (as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>)).</text>
</clause><clause id="idfdd8d573f37148f1a30bcd54a28ba682"><enum>(iii)</enum><text>The Department of Defense.</text> </clause><clause id="idaefc45ea4a29461d8cc8cad065ca2838"><enum>(iv)</enum><text>The Indian Health Service.</text>
</clause><clause id="idb746b7af65ad4d0cac7313668580af4b"><enum>(v)</enum><text>Any health care provider not otherwise covered under any of clauses (i) through (iv) that meets criteria established by the Secretary for purposes of this section.</text>
</clause></subparagraph></paragraph><paragraph id="id6f770fa2db014341be9b71bc5f90c72f"><enum>(2)</enum><header>Choice of provider</header><text>An eligible veteran who makes an election under subsection (c) to receive hospital care or medical services under this section may select a provider of such care or services from among the entities specified in paragraph (1)(B) that are accessible to the veteran.</text>
</paragraph><paragraph id="id488132e167be4b6ea1103f861a608c2c"><enum>(3)</enum><header>Coordination of care and services</header><text>The Secretary shall coordinate, through the Non-VA Care Coordination Program of the Department, the furnishing of care and services under this section to eligible veterans, including by ensuring that an eligible veteran receives an appointment for such care and services within the wait-time goals of the Veterans Health Administration for the furnishing of hospital care and medical services.</text>
</paragraph></subsection><subsection id="iddc4b124967094c7c883a321e39583c7d"><enum>(b)</enum><header>Eligible veterans</header><text>A veteran is an eligible veteran for purposes of this section if—</text> <paragraph id="id0678ef703ba344ab8ee39503e56061af"><enum>(1)</enum><text>the veteran is enrolled in the patient enrollment system of the Department established and operated under section 1705 of this title; and</text>
</paragraph><paragraph id="id74ec7226d118427a864d13bfe27040a6"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idB87511209CA84170B44ED2DD4E2C6FAC"><enum>(A)</enum><text>the veteran is unable to schedule an appointment for the receipt of hospital care or medical services from a health care provider of the Department within the lesser of—</text>
<clause id="idFBC04676BA8E47FF833113727CFC04FE" indent="up1"><enum>(i)</enum><text>the wait-time goals of the Veterans Health Administration for such care or services; or</text>
</clause><clause id="id9E1556889F45411A80B38E9DE79B70B7" indent="up1"><enum>(ii)</enum><text>a period determined by a health care provider of the Department to be clinically necessary for the receipt of such care or services;</text>
</clause></subparagraph><subparagraph id="id76dbfea2d8c84a29b456329baec81155" indent="up1"><enum>(B)</enum><text>the veteran does not reside within 40 miles driving distance from a medical facility of the Department, including a community-based outpatient clinic, with a full-time primary care physician;</text>
</subparagraph><subparagraph id="ide48a71e39b44485dabbc0a422b282c03" indent="up1"><enum>(C)</enum><text>the veteran—</text> <clause id="id6f7da44fb4724883abd75881a9028a44"><enum>(i)</enum><text>resides in a State without a medical facility of the Department that provides—</text>
<subclause id="id241df09db452416bbc92d482db38ba4f"><enum>(I)</enum><text>hospital care;</text> </subclause><subclause id="id0d101d9f9ddd49ca970f88aa5b5467da"><enum>(II)</enum><text>emergency medical services; and</text>
</subclause><subclause id="id28021d40181e46b28e9e046ff5ffb888"><enum>(III)</enum><text>surgical care rated by the Secretary as having a surgical complexity of standard; and</text> </subclause></clause><clause id="id255a9ffc71cb44ebb5ad0ef6c6e3be17"><enum>(ii)</enum><text>does not reside within 20 miles driving distance from a medical facility of the Department described in clause (i);</text>
</clause></subparagraph><subparagraph id="ida732df8c9a9e490a8283542380770525" indent="up1"><enum>(D)</enum><text>the veteran faces an unusual or excessive burden in accessing hospital care or medical services from a medical facility of the Department that is within 40 miles driving distance from the residence of the veteran due to—</text>
<clause id="id5580DE090CDE4D93A27A7A6820399E59"><enum>(i)</enum><text>geographical challenges;</text> </clause><clause id="id3AE781BB20264141932734C7C1433622"><enum>(ii)</enum><text>environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather;</text>
</clause><clause id="id23016CB12F704B0BA3EAFA55CD516F28"><enum>(iii)</enum><text>a medical condition of the veteran that affects the ability to travel; or</text>
</clause><clause id="id3CCBFE035D7242E8A5CC9FEFE6A5C4B3"><enum>(iv)</enum><text>such other factors as determined by the Secretary;</text>
</clause></subparagraph><subparagraph id="ide0ec644b30e24c5db347897ef72e95c0" indent="up1"><enum>(E)</enum><text>the veteran resides in a location, other than a location in Guam, American Samoa, or the Republic of the Philippines, that requires the veteran to travel by air, boat, or ferry to reach a medical facility of the Department, including a community-based outpatient clinic;</text>
</subparagraph><subparagraph id="idAC9C31DEB30E4D038EC6E1DE44889DA2" indent="up1"><enum>(F)</enum><text>the veteran is enrolled in the pilot program under section 403 of the Veterans’ Mental Health and Other Care Improvements Act of 2008 (<external-xref legal-doc="public-law" parsable-cite="pl/110/387">Public Law 110–387</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1703">38 U.S.C. 1703</external-xref> note) as of the date of the enactment of the <short-title>Veterans Choice Improvement Act of 2016</short-title>; or</text>
</subparagraph><subparagraph id="id93662e90440d44388d121fe02f253dee" indent="up1"><enum>(G)</enum><text>there is a compelling reason, as determined by the Secretary, that the veteran needs to receive hospital care or medical services from a medical facility other than a medical facility of the Department.</text>
</subparagraph></paragraph></subsection><subsection id="id220c12c43eef4f8ead4519f4158f7824"><enum>(c)</enum><header>Election and authorization</header>
<paragraph id="id9721efe1626545878974f38a4610d06c"><enum>(1)</enum><header>In general</header><text>In the case of an eligible veteran described in subsection (b)(2)(A), the Secretary shall, at the election of the veteran—</text>
<subparagraph id="idd872283b3de145a5b6d33ff01f68972b"><enum>(A)</enum><text>provide the veteran an appointment that exceeds the wait-time goals described in such subsection or place such veteran on an electronic waiting list described in paragraph (2) for an appointment for hospital care or medical services the veteran has elected to receive under this section; or</text>
</subparagraph><subparagraph id="id9a2bbea597204b65b92ac1fae0b86745"><enum>(B)</enum><clause commented="no" display-inline="yes-display-inline" id="idDAA1ADF5186A493E89314E71B53914BF"><enum>(i)</enum><text>authorize that such care or services be furnished to the eligible veteran under this section; and</text> </clause><clause id="id3cdd961e0fbb4b87a3c34e8e2c45c7e1" indent="up1"><enum>(ii)</enum><text>notify the eligible veteran by the most effective means available, including electronic communication or notification in writing, describing the care or services the eligible veteran is eligible to receive under this section.</text>
</clause></subparagraph></paragraph><paragraph id="id389ea8a16506432c9231c9b52a2887dc"><enum>(2)</enum><header>Electronic waiting list</header><text>The electronic waiting list described in this paragraph shall be maintained by the Department and allow access by each eligible veteran via www.myhealth.va.gov or any successor website (or other digital channel) for the following purposes:</text>
<subparagraph id="id460af3f8494840368a28d1212f34646f"><enum>(A)</enum><text>To determine the place of such eligible veteran on the waiting list.</text> </subparagraph><subparagraph id="id82af61618e3344fa8af8578453561478"><enum>(B)</enum><text>To determine the average length of time an individual spends on the waiting list, disaggregated by medical facility of the Department and type of care or service needed, for purposes of allowing such eligible veteran to make an informed election under paragraph (1).</text>
</subparagraph></paragraph></subsection><subsection id="idbe4471997d67458eb8f5309f7e0828ff"><enum>(d)</enum><header>Care and services through contracts</header>
<paragraph id="id5326037f0c994e95bc912e2ac5fb0db7"><enum>(1)</enum><header>Contracts</header>
<subparagraph id="id279c284b913849829cd3c87d64632339"><enum>(A)</enum><header>In general</header><text>Except as provided in subparagraph (B), the Secretary shall enter into contracts for furnishing care and services to eligible veterans under this section with entities specified in subsection (a)(1)(B).</text>
</subparagraph><subparagraph id="id1F9C5F5661A64325809E62A8BB227A38"><enum>(B)</enum><header>Other processes</header><text>Before entering into a contract under this paragraph, the Secretary shall, to the maximum extent practicable and consistent with the requirements of this section, furnish such care and services to such veterans under this section with such entities pursuant to sharing agreements, existing contracts entered into by the Secretary, or other processes available at medical facilities of the Department.</text>
</subparagraph><subparagraph id="id35297EB67CA84EC6AA3B34C81A4B4F7B"><enum>(C)</enum><header>Treatment of contracts</header><text>A contract entered into under this paragraph may not be treated as a Federal contract for the acquisition of goods or services and is not subject to any provision of law governing Federal contracts for the acquisition of goods or services.</text>
</subparagraph><subparagraph id="id1ea827a7790d486e9424cf9178b64768"><enum>(D)</enum><header>Contract defined</header><text>In this paragraph, the term <term>contract</term> has the meaning given that term in subpart 2.101 of the Federal Acquisition Regulation.</text> </subparagraph></paragraph><paragraph id="id66f486a167834c0db97e70b6e5d76663"><enum>(2)</enum><header>Rates and reimbursement</header> <subparagraph id="id2fca839442494394aee88466a18617f1"><enum>(A)</enum><header>In general</header><text>In entering into a contract under paragraph (1) with an entity specified in subsection (a)(1)(B), the Secretary shall—</text>
<clause id="ide112473d1a7e4f19afbd6e95f6432022"><enum>(i)</enum><text>negotiate rates for the furnishing of care and services under this section; and</text> </clause><clause id="id71bf07d988a443de9e842df7a1ac8223"><enum>(ii)</enum><text>reimburse the entity for such care and services at the rates negotiated under clause (i) as provided in such contract.</text>
</clause></subparagraph><subparagraph id="id71e41166874945e1a1b82f86096896bb"><enum>(B)</enum><header>Limit on rates</header>
<clause id="id7eef48f80e0147c286402a0dce85aabd"><enum>(i)</enum><header>In general</header><text>Except as provided in clause (ii), rates negotiated under subparagraph (A)(i) shall not be more than the rates paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(u)</external-xref>)) or a supplier (as defined in section 1861(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(d)</external-xref>)) under the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) for the same care or services.</text>
</clause><clause id="id7a7ff720273b4a26a147db5ef54a30eb"><enum>(ii)</enum><header>Exceptions</header>
<subclause id="id92df1c7f4d3f4cf0a5cf1dba4a1cd848"><enum>(I)</enum><header>In general</header><text>The Secretary may negotiate a rate that is more than the rate paid by the United States as described in clause (i) with respect to the furnishing of care or services under this section to an eligible veteran who resides in a highly rural area.</text>
</subclause><subclause id="idbee6993a86cc4307b84f9d07c6235d1e"><enum>(II)</enum><header>Other exceptions</header>
<item id="id16083E747640458E9DE20AFF5FD801CE"><enum>(aa)</enum><header>Alaska</header><text>With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs will be followed, except for when another payment agreement, including a contract or provider agreement, is in place.</text>
</item><item id="id8D60EA5472544EE98976276D94F0D678"><enum>(bb)</enum><header>Other States</header><text>With respect to care or services furnished under this section in a State with an All-Payer Model Agreement in effect under section 1814 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395f">42 U.S.C. 1395f</external-xref>), the Medicare payment rates under clause (i) shall be calculated based on the payment rates under such agreement.</text>
</item></subclause><subclause id="id066274c5a38e42cca5133471a7b464db"><enum>(III)</enum><header>Highly rural area defined</header><text>In this clause, the term <term>highly rural area</term> means an area located in a county that has fewer than seven individuals residing in that county per square mile.</text>
</subclause></clause></subparagraph><subparagraph id="id76b9ec061bab4440be1e476f5c87bcf6"><enum>(C)</enum><header>Limit on collection</header><text>For the furnishing of care or services pursuant to a contract under paragraph (1), an entity specified in subsection (a)(1)(B) may not collect any amount that is greater than the rate negotiated pursuant to subparagraph (A)(i).</text>
</subparagraph></paragraph></subsection><subsection id="id8a29840ef09549a5aa1ccc7b21243f1c"><enum>(e)</enum><header>Veterans choice card</header>
<paragraph id="id5cf863836dd74aa3bee6bf9ccc916d92"><enum>(1)</enum><header>In general</header><text>For purposes of receiving care and services under this section, the Secretary shall issue to each veteran described in subsection (b)(1) a card that may be presented to a health care provider to facilitate the receipt of care or services under this section.</text>
</paragraph><paragraph id="id06d7e268212e4260bdc1a310d6b102a0"><enum>(2)</enum><header>Name of card</header><text>Each card issued under paragraph (1) shall be known as a <quote>Veterans Choice Card</quote>.</text> </paragraph><paragraph id="id21fecc8905b5441589705e4e7582bb26"><enum>(3)</enum><header>Details of card</header><text>Each Veterans Choice Card issued to a veteran under paragraph (1) shall include the following:</text>
<subparagraph id="idad692cec20fe4b31acc3964c9786ab82"><enum>(A)</enum><text>The name of the veteran.</text> </subparagraph><subparagraph id="id3eb3817e19ce4d49a9b4c4b0d8830cb6"><enum>(B)</enum><text>An identification number for the veteran that is not the social security number of the veteran.</text>
</subparagraph><subparagraph id="id5e4f86a8b667443592d29fdbcb98fb1c"><enum>(C)</enum><text>The contact information of an appropriate office of the Department for health care providers to confirm that care or services under this section are authorized for the veteran.</text>
</subparagraph><subparagraph id="id97491213a8a34084a5326f456f2b17f2"><enum>(D)</enum><text>Contact information and other relevant information for the submittal of claims or bills for the furnishing of care or services under this section.</text>
</subparagraph><subparagraph id="ide96c9724dd314503a079013a855d3382"><enum>(E)</enum><text>The following statement: <quote>This card is for qualifying medical care outside the Department of Veterans Affairs. Please call the Department of Veterans Affairs phone number specified on this card to ensure that treatment has been authorized.</quote>.</text>
</subparagraph></paragraph><paragraph id="idc3af97c810cc46a590ef90841048e3c7"><enum>(4)</enum><header>Information on use of card</header><text>Upon issuing a Veterans Choice Card to a veteran, the Secretary shall provide the veteran with information clearly stating the circumstances under which the veteran may be eligible for care or services under this section.</text>
</paragraph></subsection><subsection id="id2d0ee716f7db4e40832258c5b12f63f3"><enum>(f)</enum><header>Information on availability of care</header><text>The Secretary shall provide information to a veteran about the availability of care and services under this section in the following circumstances:</text>
<paragraph id="id96f4ede7394f41c5a4c38bd7330a699b"><enum>(1)</enum><text>When the veteran enrolls in the patient enrollment system of the Department established and operated under section 1705 of this title.</text>
</paragraph><paragraph id="ida327d6ad72914ff9bce624e5c999c265"><enum>(2)</enum><text>When the veteran attempts to schedule an appointment for the receipt of hospital care or medical services from the Department but is unable to schedule an appointment within the wait-time goals of the Veterans Health Administration for the furnishing of such care or services.</text>
</paragraph><paragraph id="id144141fd42c34a6fa97ec414eb32ab05"><enum>(3)</enum><text>When the veteran becomes eligible for hospital care or medical services under this section under subparagraph (B), (C), (D), (E), (F), or (G) of subsection (b)(2).</text>
</paragraph></subsection><subsection id="id60fc0079f61d42958dae7e4a74dd7e50"><enum>(g)</enum><header>Follow-Up care</header><text>The Secretary shall ensure that, at the election of an eligible veteran who receives hospital care or medical services from a health care provider in an episode of care under this section, the veteran receives such care or services from that health care provider or another health care provider selected by the veteran, including a health care provider of the Department, through the completion of the episode of care, including all specialty and ancillary services deemed necessary as part of the treatment recommended in the course of such care or services.</text>
</subsection><subsection id="id0c894a47d2414e21a875bd6baae882ae"><enum>(h)</enum><header>Providers</header><text>To be eligible to furnish care or services under this section, a health care provider must—</text> <paragraph id="id80a5187e19394e40a0e4f7a71d80be70"><enum>(1)</enum><text>maintain at least the same or similar credentials and licenses as those credentials and licenses that are required of health care providers of the Department, as determined by the Secretary for purposes of this section; and</text>
</paragraph><paragraph id="idf63569f9442d4fa6ac21b754086ff5d4"><enum>(2)</enum><text>submit, not less frequently than annually, verification of such licenses and credentials maintained by such health care provider.</text>
</paragraph></subsection><subsection id="idffba27c287a14b34b56de427aa060cbe"><enum>(i)</enum><header>Cost-Sharing</header>
<paragraph id="id136df695480f4f66854b97fd9f9f9e6a"><enum>(1)</enum><header>In general</header><text>The Secretary shall require an eligible veteran to pay a copayment for the receipt of care or services under this section only if such eligible veteran would be required to pay a copayment for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department under this chapter.</text>
</paragraph><paragraph id="idb82e92daae794fa28ba38e8f9ba7c276"><enum>(2)</enum><header>Limitation</header><text>The amount of a copayment charged under paragraph (1) may not exceed the amount of the copayment that would be payable by such eligible veteran for the receipt of such care or services at a medical facility of the Department or from a health care provider of the Department under this chapter.</text>
</paragraph></subsection><subsection commented="no" id="idb2cb65fc672c482da9fac4d93417fb2d"><enum>(j)</enum><header>Claims processing system</header>
<paragraph commented="no" id="idefba064d60bb4da8973cdc430cf01969"><enum>(1)</enum><header>In general</header><text>The Secretary shall provide for an efficient nationwide system for prompt processing and paying of bills or claims for authorized care and services furnished to eligible veterans under this section.</text>
</paragraph><paragraph commented="no" id="idad61d47a05e3438382fefb0f32a4920d"><enum>(2)</enum><header>Oversight</header><text>The Chief Business Office of the Veterans Health Administration shall oversee the implementation and maintenance of such system.</text>
</paragraph><paragraph commented="no" id="id685eff9222ed47a79941a30c23fcff01"><enum>(3)</enum><header>Accuracy of payment</header>
<subparagraph commented="no" id="id960ffa6425f044bb86a0f59b5b0dc2c6"><enum>(A)</enum><header>In general</header><text>The Secretary shall ensure that such system meets such goals for accuracy of payment as the Secretary shall specify for purposes of this section.</text>
</subparagraph><subparagraph commented="no" id="id666ef3fe0d504c4d9fc6a6ca33ee4ea0"><enum>(B)</enum><header>Quarterly report</header>
<clause commented="no" id="idb5f28dbae9d14a3884d1423326848ccd"><enum>(i)</enum><header>In general</header><text>The Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a quarterly report on the accuracy of such system.</text>
</clause><clause commented="no" id="id5369b2506e7d4a1993c621d5565567d9"><enum>(ii)</enum><header>Elements</header><text>Each report required by clause (i) shall include the following:</text> <subclause commented="no" id="ida59c2bf6f3234c7da82f791adea2723c"><enum>(I)</enum><text>A description of the goals for accuracy for such system specified by the Secretary under subparagraph (A).</text>
</subclause><subclause commented="no" id="idbb3e802117b945499c497571dca96ec4"><enum>(II)</enum><text>An assessment of the success of the Department in meeting such goals during the quarter covered by the report.</text>
</subclause></clause><clause commented="no" id="idb07ec42462304e4daa5671751e9f2dcc"><enum>(iii)</enum><header>Deadline</header><text>The Secretary shall submit each report required by clause (i) not later than 20 days after the end of the quarter covered by the report.</text>
</clause></subparagraph></paragraph></subsection><subsection id="id747a6d99cb094decb029bfc261674b0d"><enum>(k)</enum><header>Medical records</header>
<paragraph id="id7d33085368c049d1a7ddfed2c1317de2"><enum>(1)</enum><header>In general</header><text>The Secretary shall ensure that any health care provider that furnishes care or services under this section to an eligible veteran submits to the Department a copy of any medical record related to the care or services provided to such veteran by such health care provider for inclusion in the electronic medical record of such veteran maintained by the Department upon the completion of the provision of such care or services to such veteran.</text>
</paragraph><paragraph id="idba5e92094e26471e996cd1d84f293f2d"><enum>(2)</enum><header>Electronic format</header><text>Any medical record submitted to the Department under paragraph (1) shall, to the extent possible, be in an electronic format.</text>
</paragraph></subsection><subsection commented="no" id="idf72b41a43f1041d79cd6c6ce343879f6"><enum>(l)</enum><header>Records not required for reimbursement</header><text>With respect to care or services furnished to an eligible veteran by a health care provider under this section, the receipt by the Department of a medical record under subsection (k) detailing such care or services is not required before reimbursing the health care provider for such care or services.</text>
</subsection><subsection id="idbd9fd569acc44bf3a046441abfb5c106"><enum>(m)</enum><header>Tracking of missed appointments</header><text>The Secretary shall implement a mechanism to track any missed appointments for care or services under this section by eligible veterans to ensure that the Department does not pay for such care or services that were not furnished to an eligible veteran.</text>
</subsection><subsection id="id452d8c46d6084e3eba765db31b9b12e7"><enum>(n)</enum><header>Rules of construction</header>
<paragraph id="id373B8C9F09A643E884DCB5897A500AE3"><enum>(1)</enum><header>Prescription medications</header><text>Nothing in this section shall be construed to alter the process of the Department for filling and paying for prescription medications.</text>
</paragraph><paragraph id="id4bf1a697c56f4ceebe411bd7096129c4"><enum>(2)</enum><header>Tiered network</header><text>Nothing in this section shall be construed to authorize the creation of a tiered network in which an eligible veteran would be required to receive care or services from an entity in a higher tier than any other entity or provider network.</text>
</paragraph></subsection><subsection id="idAB3907B0C0C64F518C7CD889933020B8"><enum>(o)</enum><header>Wait-Time goals of the Veterans Health Administration</header>
<paragraph id="id5def1a33377e432496d4f451d8f070ca"><enum>(1)</enum><header>In general</header><text>Except as provided in paragraph (2), in this section, the term <term>wait-time goals of the Veterans Health Administration</term> means not more than 30 days from the date on which a veteran requests an appointment for hospital care or medical services from the Department.</text>
</paragraph><paragraph id="id0f7daa6ebe434987b86404dbfc4fddda"><enum>(2)</enum><header>Alternate goals</header><text>If the Secretary submits to Congress, not later than 180 days after the date of the enactment of the <short-title>Veterans Choice Improvement Act of 2016</short-title>, a report stating that the actual wait-time goals of the Veterans Health Administration are different from the wait-time goals specified in paragraph (1)—</text>
<subparagraph id="idb66e237e5fc2440b934a9222f0f1247f"><enum>(A)</enum><text>for purposes of this section, the wait-time goals of the Veterans Health Administration shall be the wait-time goals submitted by the Secretary under this paragraph; and</text>
</subparagraph><subparagraph id="ideb01634385234b57b5c61e2440f844cf"><enum>(B)</enum><text>the Secretary shall publish such wait-time goals in the Federal Register and on an Internet website of the Department available to the public.</text>
</subparagraph></paragraph></subsection><subsection id="id83a24ec1c7a948dfbaa793cfd46a5a2a"><enum>(p)</enum><header>Waiver of certain printing requirements</header><text>Section 501 of title 44 shall not apply in carrying out this section.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph><paragraph id="id685D4D02781040E9B4214DA3F35A1839"><enum>(2)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1703 the following new item:</text>
<quoted-block id="id4b63fc13-7cb7-49a1-8880-28aa5d8f7bfe" style="USC"><toc><toc-entry idref="id86957dccf04a46e8994db8cc7c4ca7d5" level="section">1703A. Veterans Choice Program.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="id2A92683AB68C400C996BCCCDC9AC5E79"><enum>(3)</enum><header>Conforming repeal</header>
<subparagraph id="idB9ED9B433FB3487ABE4AEFF59CEB2079"><enum>(A)</enum><header>In general</header><text>Section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is repealed.</text>
</subparagraph><subparagraph commented="no" id="id7C161ED08E6F495CB6711811E004C18E"><enum>(B)</enum><header>Conforming amendment</header><text>Section 208(1) of such Act is amended by striking <quote>section 101</quote> and inserting <quote>section 1703A of title 38, United States Code</quote>.</text> </subparagraph></paragraph><paragraph id="idce0561ad83984c24b897ff0f6423e35f"><enum>(4)</enum><header>Report</header><text>Not later than 180 days after the date of the enactment of this Act, 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 furnishing of care and services under section 1703A of title 38, United States Code, as added by paragraph (1), that includes the following:</text>
<subparagraph id="idc94f37f1a0784317a902a2e52d0ba57e"><enum>(A)</enum><text>The total number of veterans who have received care or services under this section, disaggregated by—</text>
<clause id="id619df0ad81ee485094a796b3e959664f"><enum>(i)</enum><text>eligible veterans described in subsection (b)(2)(A) of such section;</text> </clause><clause id="id7519da6b511a425c805cf8dd24c9e9d2"><enum>(ii)</enum><text>eligible veterans described in subsection (b)(2)(B) of such section;</text>
</clause><clause id="idf7e34f60ec91402f9c5e3aa755064573"><enum>(iii)</enum><text>eligible veterans described in subsection (b)(2)(C) of such section;</text> </clause><clause id="id9e1672b2eb7642218733d68794392768"><enum>(iv)</enum><text>eligible veterans described in subsection (b)(2)(D) of such section;</text>
</clause><clause id="id9CB675CA35F34227BF1E51F86A2C9860"><enum>(v)</enum><text>eligible veterans described in subsection (b)(2)(E) of such section;</text> </clause><clause id="id939840FAC95246E19678DF37FF71D056"><enum>(vi)</enum><text>eligible veterans described in subsection (b)(2)(F) of such section; and</text>
</clause><clause id="id291188EDB5E74DC184646A60C81662C0"><enum>(vii)</enum><text>eligible veterans described in subsection (b)(2)(G) of such section.</text> </clause></subparagraph><subparagraph id="id531c5f5011cd4aabb01c6d36b441ea8e"><enum>(B)</enum><text>A description of the types of care and services furnished to veterans under such section.</text>
</subparagraph><subparagraph id="id7ba6e886d2e64488b5039b86e9115ab0"><enum>(C)</enum><text>An accounting of the total cost of furnishing care and services to veterans under such section.</text>
</subparagraph><subparagraph id="id8578a1a720de48a2b71d9843ce4bf1e0"><enum>(D)</enum><text>The results of a survey of veterans who have received care or services under such section on the satisfaction of such veterans with the care or services received by such veterans under such section.</text>
</subparagraph><subparagraph id="idad934c45390545feb94d0b63ff442a0f"><enum>(E)</enum><text>An assessment of the effect of furnishing care and services under such section on wait times for appointments for the receipt of hospital care and medical services from the Department of Veterans Affairs.</text>
</subparagraph></paragraph></subsection><subsection id="id3B9A783696E345678FA394000046EB79"><enum>(b)</enum><header>Consolidation of services</header>
<paragraph id="id9A3F1AACE4F94E969EB85B5D465B5357"><enum>(1)</enum><header>In general</header><text>Not later than December 31, 2017, the Secretary of Veterans Affairs shall consolidate the following programs, contracts, and agreements of the Department of Veterans Affairs:</text>
<subparagraph id="idD1B16E12887D4EBB9E3FDAEA73C326F8"><enum>(A)</enum><text>The Patient-Centered Community Care program (commonly referred to as <quote>PC3</quote>).</text> </subparagraph><subparagraph id="id859d4cd15c3a462cb8fe708ce7ae5997"><enum>(B)</enum><text>Contracts to provide kidney dialysis services.</text>
</subparagraph><subparagraph id="id1c110322e1b3483f9de64a5a0b6b6f7a"><enum>(C)</enum><text>Contracts through the retail pharmacy network of the Department.</text> </subparagraph><subparagraph commented="no" id="id61FED26211534D22A25FF342FB41B89B"><enum>(D)</enum><text>Veterans Care Agreements under section 1703C of title 38, United States Code, as added by section 201(a).</text>
</subparagraph><subparagraph id="id89e498400854493ebd540a1e940825f9"><enum>(E)</enum><text>Health care agreements with Federal entities or entities funded by the Federal Government, including the Department of Defense, the Indian Health Service, tribal health programs, Federally-qualified health centers (as defined in section 1905(l)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d(l)(2)(B)</external-xref>)), and academic teaching affiliates.</text>
</subparagraph></paragraph><paragraph id="id66E43C4AE35F4E8992019628A01A1EAA"><enum>(2)</enum><header>Classification of services</header><text>Services provided under the programs, contracts, and agreements consolidated under paragraph (1) shall be considered services provided under the Veterans Choice Program established under section 1703A of title 38, United States Code, as added by subsection (a)(1).</text>
</paragraph><paragraph id="idDF0F5536C2CC4F02AC3DFFAE6AE3599D"><enum>(3)</enum><header>Rule of construction</header><text>Nothing in this subsection shall be construed to authorize the creation of a tiered network in which an entity or entities would be placed in a higher tier than any other entity or provider network.</text>
</paragraph></subsection></section><section id="idd47bbb6979fa41c581f950272b08351d"><enum>102.</enum><header>Funding for Veterans Choice Program</header>
<subsection id="id65193cb9c47542a4917649a4a9b6712a"><enum>(a)</enum><header>In general</header><text>All amounts required to carry out the Veterans Choice Program shall be derived from the appropriations account established in section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (<external-xref legal-doc="public-law" parsable-cite="pl/114/41">Public Law 114–41</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note).</text>
</subsection><subsection id="idD4DFC35B963B4FC6A906B6AE80E923D2"><enum>(b)</enum><header>Transfer of amounts</header>
<paragraph id="idFD53C3CEC3B84897BB1C9A7CD729E8FB"><enum>(1)</enum><header>In general</header><text>All amounts in the Veterans Choice Fund under section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) shall be transferred to the appropriations account established in section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (<external-xref legal-doc="public-law" parsable-cite="pl/114/41">Public Law 114–41</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note).</text>
</paragraph><paragraph id="idB09DC4B8510242A891C71A3912CC4359"><enum>(2)</enum><header>Conforming repeal</header>
<subparagraph id="idB6A4F7B2A3DE4647A81284DBD87ECE1B"><enum>(A)</enum><header>In general</header><text>Section 802 of the Veterans Access, Choice, and Accountability Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/146">Public Law 113–146</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is repealed.</text>
</subparagraph><subparagraph id="idC3AF3034E01A4490BCD4BAF2E15D90F4"><enum>(B)</enum><header>Conforming amendment</header><text>Section 4003 of the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 (<external-xref legal-doc="public-law" parsable-cite="pl/114/41">Public Law 114–41</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1701">38 U.S.C. 1701</external-xref> note) is amended by striking <quote>to be comprised of</quote> and all that follows and inserting <quote>to be comprised of discretionary medical services funding that is designated for hospital care and medical services furnished at non-Department facilities</quote>.</text>
</subparagraph></paragraph></subsection><subsection id="id9ef44752cb0b4069b31de58953a4c199"><enum>(c)</enum><header>Obligation of funds</header><text>Without regard to the requirements of sections 1501 and 1341(a)(1) of title 31, United States Code, the Secretary may record obligations under the Veteran Choice Program if the amount of the obligation is certain in order for the Department to avoid large deobligation amounts after the funds have expired.</text>
</subsection><subsection id="id7914bace2e62467ebf442d8037ad8bf4"><enum>(d)</enum><header>Streamlined funding</header>
<paragraph id="idBE69D5F2DC584C4389F782A44421EC51"><enum>(1)</enum><header>Provision of funds</header><text>The Chief Business Office of the Veterans Health Administration may provide funds for a fiscal year to medical centers of the Department, if requested by the medical center, for costs relating to furnishing non-Department care under the Veterans Choice Program, including administrative costs associated with the management and accounting of such funds, and may adjust such funding if appropriate.</text>
</paragraph><paragraph id="id7354F03426524A61BC15CA54A6085666"><enum>(2)</enum><header>Submittal of funding requests by medical centers</header><text>Medical centers of the Department may submit funding requests to the Chief Business Office for costs described in subparagraph (A).</text>
</paragraph><paragraph id="idF1FFA7D680B04D939673FF80C096FD85"><enum>(3)</enum><header>Use of funds</header><text>Funds provided under subparagraph (A) may be used only for the costs specified in such subparagraph and are not eligible to be reprogrammed for any other purpose.</text>
</paragraph></subsection><subsection id="idc7131364979e4e9d971a5360b63aa2c1"><enum>(e)</enum><header>Report</header>
<paragraph id="id5194C60BD1CD42F997B641E077B6FEEC"><enum>(1)</enum><header>In general</header><text>Not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs shall submit to the appropriate committees of Congress a report that includes the following:</text>
<subparagraph id="id5a595490666b4678a04294e8ad8c50df"><enum>(A)</enum><text>The amount of funds required to carry out the Veterans Choice Program for fiscal year 2017.</text> </subparagraph><subparagraph id="id8df4d79e9de143e5bd747a2f297b525d"><enum>(B)</enum><text>The number of veterans, disaggregated by fiscal year, who received health care services under the programs, contracts, and agreements that make up the Veterans Choice Program during the period beginning on October 1, 2011, and ending on September 30, 2015.</text>
</subparagraph><subparagraph id="idc5c214cd0e904903aeb88e1f3b2a08d0"><enum>(C)</enum><text>An evaluation of whether the accounting processes of the Department are sufficient to properly account for expenditures from a consolidated appropriations account under paragraph (1), including an identification of each known deficiency and potential deficiency of such processes.</text>
</subparagraph><subparagraph id="id8e396b61201f454bac95b0664fa27dbf"><enum>(D)</enum><text>For each deficiency identified under clause (iii), a detailed plan to remedy the deficiency and an assessment of whether the Department has adequate resources to remedy the deficiency.</text>
</subparagraph><subparagraph id="id0aaaf31e73034624929e8c9a6890596c"><enum>(E)</enum><text>For each deficiency identified under clause (iii) that requires new or improved information technology to remedy, an evaluation of whether there is commercially available technology that may be suitable to remedy the deficiency.</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id6c2a0f88f8834b8da56438b65e627043"><enum>(F)</enum><text>A cost estimate for remedying each deficiency identified under clause (iii).</text> </subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="idF88BFA6AA8A84251B1D2F3584C4AAD4A"><enum>(2)</enum><header>Appropriate committees of Congress defined</header><text>In this paragraph, the term <term>appropriate committees of Congress</term> means—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="id9A63F485416A4356AF0C39D90E949A69"><enum>(A)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and</text> </subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idDD7574A7EF5F4E26A8820A61BE041E15"><enum>(B)</enum><text>the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.</text>
</subparagraph></paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id09553AACA32C427C98B6A2C287423DE9"><enum>(f)</enum><header>Veterans Choice Program defined</header><text>In this subsection, the term <term>Veterans Choice Program</term> means—</text> <paragraph commented="no" display-inline="no-display-inline" id="id077BD2DFAE524D3E84BE25BA66FAD84E"><enum>(1)</enum><text>the program under section 1703A of title 38, United States Code, as added by section 101(a)(1); and</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idF8A63334E7A24D67B01CB09E780433B1"><enum>(2)</enum><text>the programs, contracts, and agreements of the Department consolidated under section 101(b).</text> </paragraph></subsection></section><section id="idd0927a43f7a54ca3b91f11eba531c6aa"><enum>103.</enum><header>Payment of health care providers under Veterans Choice Program</header> <subsection id="id8DEA231850264CF6B6ECDB5770338BB4"><enum>(a)</enum><header>Payment of providers</header> <paragraph id="id910DA898D7C9410F9EC2F96839D7549B"><enum>(1)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, as amended by section 101(a)(1), is further amended by inserting after section 1703A the following new section:</text>
<quoted-block display-inline="no-display-inline" id="idDF96C4C6973149CA9D8C3F34A9F57DAD" style="USC">
<section id="id2607C8D022674CD386CA8A623CE23DE1"><enum>1703B.</enum><header>Veterans Choice Program: payment of health care providers</header>
<subsection id="id3c6f23ca713f4ab0b940a01fda9070ee"><enum>(a)</enum><header>Prompt payment compliance</header><text>The Secretary shall ensure that payments made to health care providers under the Veterans Choice Program comply with <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/31/39">chapter 39</external-xref> of title 31 (commonly referred to as the <quote>Prompt Payment Act</quote>) and the requirements of this section. If there is a conflict between the requirements of the Prompt Payment Act and the requirements of this section, the Secretary shall comply with the requirements of this section.</text>
</subsection><subsection id="idd33376974c414836bb317bf9fa95d5a9"><enum>(b)</enum><header>Payment schedule</header><paragraph commented="no" display-inline="yes-display-inline" id="id5936FF0BC1334139AE35BDBCFBBA1260"><enum>(1)</enum><text display-inline="yes-display-inline">The Secretary shall reimburse a health care provider for care or services furnished under the Veterans Choice Program—</text>
<subparagraph id="id8AD5C0F29648466B843B518EC2A1792B" indent="up1"><enum>(A)</enum><text display-inline="yes-display-inline">in the case of a clean claim submitted to the Secretary electronically, not later than 30 days after receiving the claim; or</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="id284D7D6003294195AE9302A03E99D979" indent="up1"><enum>(B)</enum><text display-inline="yes-display-inline">in the case of a clean claim submitted to the Secretary in a manner other than electronically, not later than 45 days after receiving the claim.</text>
</subparagraph></paragraph><paragraph id="idb55812464d2040dba396c1718455d26c" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id4D7ECD03896541EEBCFB9AC077952143"><enum>(A)</enum><text>If the Secretary determines that a claim received from a health care provider for care or services furnished under the Veterans Choice Program is a non-clean claim, the Secretary shall submit to the provider, not later than 10 days after receiving the claim—</text>
<clause id="id4E963FE07C534537BFCE7E8855CD16D6" indent="up1"><enum>(i)</enum><text>a notification that the claim is a non-clean claim;</text> </clause><clause id="id983B8FB8013D4C8F847851AE16D83A9A" indent="up1"><enum>(ii)</enum><text>an explanation of why the claim has been determined to be a non-clean claim; and</text>
</clause><clause id="id5988D46DBD214D1E867F62CD2BA965B3" indent="up1"><enum>(iii)</enum><text>an identification of the information or documentation that is required to make the claim a clean claim.</text>
</clause></subparagraph><subparagraph id="idd07a61db981c4b189a61df2104995e9b" indent="up1"><enum>(B)</enum><text>If the Secretary does not comply with the requirements of subparagraph (A) with respect to a claim, the claim shall be deemed a clean claim for purposes of paragraph (1).</text>
</subparagraph></paragraph><paragraph id="id851ae7c5a97142d488d297e643f08468" indent="up1"><enum>(3)</enum><text>Upon receipt by the Secretary of information or documentation described in subparagraph (A)(iii) with respect to a claim, the Secretary shall reimburse a health care provider for care or services furnished under the Veterans Choice Program—</text>
<subparagraph id="idF98ED7B4A97444BD8F791E297C935412"><enum>(A)</enum><text>in the case of a claim submitted to the Secretary electronically, not later than 30 days after receiving such information or documentation; or</text>
</subparagraph><subparagraph id="id255822CC534046BC8EA418C4F551A12B"><enum>(B)</enum><text>in the case of claim submitted to the Secretary in a manner other than electronically, not later than 45 days after receiving such information or documentation.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="id6465056a61d54e0ba92f58f1551c6f85" indent="up1"><enum>(4)</enum><text>If the Secretary fails to comply with the deadlines for payment set forth in this subsection with respect to a claim, interest shall accrue on the amount owed under such claim in accordance with section 3902 of title 31, United States Code.</text>
</paragraph></subsection><subsection id="idd0726dd85ae64072bc4c3d8851268b91"><enum>(c)</enum><header>Information and documentation required</header><paragraph commented="no" display-inline="yes-display-inline" id="id9D4CC0127FF0489AAA7EFC21B443CD75"><enum>(1)</enum><text>The Secretary shall provide to all health care providers participating in the Veterans Choice Program a list of information and documentation that is required to establish a clean claim under this section.</text>
</paragraph><paragraph id="id691ebea96d05453e98f37b3b42028f53" indent="up1"><enum>(2)</enum><text>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).</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="idedcf7f712c794858b85c2ffc5a1fff72" indent="up1"><enum>(3)</enum><text>If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care providers participating in the Veterans Choice Program not later than 30 days before such modifications take effect.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="idAD047AFC7F4F4931B7544F4CCAF288C1"><enum>(d)</enum><header>Electronic claim submittal</header><text>On and after January 1, 2019, the Secretary shall not accept any claim under this section that is submitted to the Secretary in a manner other than electronically.</text>
</subsection><subsection id="id74d6a2121212473382dfc70fd2efab0b"><enum>(e)</enum><header>Definitions</header><text>In this section:</text> <paragraph id="idD1BA79FDBA60494E9E1EE9F9E6F0A292"><enum>(1)</enum><text>The term <term>clean claim</term> means a claim for reimbursement for care or services furnished under the Veterans Choice Program, on a nationally recognized standard format, that includes the information and documentation necessary to adjudicate the claim.</text>
</paragraph><paragraph id="id0e0ac0de5111426e8efaedfd28eb196e"><enum>(2)</enum><text>The term <term>non-clean claim</term> means a claim for reimbursement for care or services furnished under the Veterans Choice Program, on a nationally recognized standard format, that does not include the information and documentation necessary to adjudicate the claim.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id255A8D2F228745C4984A36CA516FDE2A"><enum>(3)</enum><text>The term <term>Veterans Choice Program</term> means—</text> <subparagraph commented="no" display-inline="no-display-inline" id="id987F1FE8B8BE444297742E984C23B90B"><enum>(A)</enum><text>the program under section 1703A of this title; and</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="idA899A57064B343ED80315C8A28AFAA78"><enum>(B)</enum><text>the programs, contracts, and agreements of the Department consolidated under section 101(b) of the <short-title>Veterans Choice Improvement Act of 2016</short-title>.</text></subparagraph></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph><paragraph id="id16B67046A640410B8B51BEDE402E4F87"><enum>(2)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title, as amended by section 101(a)(2), is further amended by inserting after the item related to section 1703A the following new item:</text>
<quoted-block display-inline="no-display-inline" id="id4DCD12B988CD49BE8EB6433AE66E087A" style="OLC"><toc><toc-entry bold="off" level="section">1703B. Veterans Choice Program: payment of health care providers.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id5c77b1aabb6c44c183740e10d01f4d63"><enum>(b)</enum><header>Electronic submittal of claims for reimbursement</header>
<paragraph id="id3b61bd3e4c3342af991cc57a7bad6d14"><enum>(1)</enum><header>Prohibition on acceptance of non-electronic claims</header>
<subparagraph id="idE5863071098F4E6DA050AEFB07C797F7"><enum>(A)</enum><header>In general</header><text>Except as provided in subparagraph (B), on and after January 1, 2019, the Secretary of Veterans Affairs shall not accept any claim for reimbursement under section 1703B of title 38, United States Code, as added by subsection (a), that is submitted to the Secretary in a manner other than electronically, including medical records in connection with such a claim.</text>
</subparagraph><subparagraph id="id40f03bc4964c485cae56ebf9db4f4929"><enum>(B)</enum><header>Exception</header><text>If the Secretary determines that accepting claims and medical records in a manner other than electronically is necessary for the timely processing of claims for reimbursement under such section 1703B due to a failure or malfunction of the electronic interface established under paragraph (2), the Secretary—</text>
<clause id="id8CC16CCB67A24AB28C8EDE177655479A"><enum>(i)</enum><text>may accept claims and medical records in a manner other than electronically for a period not to exceed 90 days; and</text>
</clause><clause id="idA94D7FAD502D481E86F8F79503B8FF60"><enum>(ii)</enum><text>shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth—</text>
<subclause id="id6862BB49D51C4F09B3AD6DB118D34989"><enum>(I)</enum><text>the reason for accepting claims and medical records in a manner other than electronically;</text> </subclause><subclause id="id3AB96CD55E0B4B4EA97CFB83978D555B"><enum>(II)</enum><text>the duration of time that the Department of Veterans Affairs will accept claims and medical records in a manner other than electronically; and</text>
</subclause><subclause id="id13C821F9A5CA45C0A804C56879A78F87"><enum>(III)</enum><text>the steps that the Department is taking to resolve such failure or malfunction.</text> </subclause></clause></subparagraph></paragraph><paragraph id="idF2C79056FFA049BF9AA6706D8615768C"><enum>(2)</enum><header>Electronic interface</header> <subparagraph id="id2e10e99bc4504240b1419eedb13db53b"><enum>(A)</enum><header>In general</header><text>Not later than January 1, 2019, the Chief Information Officer of the Department of Veterans Affairs shall establish an electronic interface for health care providers to submit claims for reimbursement under such section 1703B.</text>
</subparagraph><subparagraph id="id997cab3b8cc04849bd195b7c4b3aa2c7"><enum>(B)</enum><header>Functions</header><text>The electronic interface established under subparagraph (A) shall include the following functions:</text> <clause id="id14E1E965AC3A465C8A552D5DD7C03379"><enum>(i)</enum><text>A function through which a health care provider may input all relevant data required for claims submittal and reimbursement.</text>
</clause><clause id="id78354dab84134bb4bd20a2356d9e007d"><enum>(ii)</enum><text>A function through which a health care provider may upload medical records to accompany a claim for reimbursement.</text>
</clause><clause id="idc291a9e3235642e69b7bb140475b2535"><enum>(iii)</enum><text>A function through which a health care provider may ascertain the status of a pending claim for reimbursement that—</text>
<subclause id="id7EF0F0FADCB14352A9A65EBD5113703C"><enum>(I)</enum><text>indicates whether the claim is a clean claim or a non-clean claim; and</text> </subclause><subclause id="idB9D766A42D6C406098A70216F672CBE1"><enum>(II)</enum><text>in the event that a submitted claim is indicated as a non-clean claim, provides—</text>
<item id="idE0E3EE3574C24B73B989FE93D408550A"><enum>(aa)</enum><text>an explanation of why the claim has been determined to be a non-clean claim; and</text> </item><item id="id1FA201CF62434DA99148BB57C2A0710C"><enum>(bb)</enum><text>an identification of the information or documentation that is required to make the claim a clean claim.</text>
</item></subclause></clause><clause id="id485c83252992403fa1d79bfbbdab9da6"><enum>(iv)</enum><text>A function through which a health care provider is notified when a claim for reimbursement is accepted or rejected.</text>
</clause><clause id="id439e4da325834e1d864bc88dfe0ff684"><enum>(v)</enum><text>Such other features as the Secretary considers necessary.</text> </clause></subparagraph><subparagraph commented="no" id="id7e7e31efc8ce45029ac485a69087a7b7"><enum>(C)</enum><header>Protection of information</header> <clause commented="no" id="idFC05FCBF10464E94A824A704004D73A7"><enum>(i)</enum><header>In general</header><text>The electronic interface established under subparagraph (A) shall be developed and implemented based on industry-accepted information security and privacy engineering principles and best practices and shall provide for the following:</text>
<subclause commented="no" id="idc2369612e9bd43e2873227056d544c60"><enum>(I)</enum><text>The elicitation, analysis, and prioritization of functional and nonfunctional information security and privacy requirements for such interface, including specific security and privacy services and architectural requirements relating to security and privacy based on a thorough analysis of all reasonably anticipated cyber and noncyber threats to the security and privacy of electronic protected health information made available through such interface.</text>
</subclause><subclause commented="no" id="id371489bd6e9449b99b397aa671608f3c"><enum>(II)</enum><text>The elicitation, analysis, and prioritization of secure development requirements relating to such interface.</text>
</subclause><subclause commented="no" id="ida26937e6b2dd487e8d67fb7a257ea188"><enum>(III)</enum><text>The assurance that the prioritized information security and privacy requirements of such interface—</text> <item commented="no" id="id1A567FF399EB486EBA78C73DDBEBBA26"><enum>(aa)</enum><text>are correctly implemented in the design and implementation of such interface throughout the system development lifecycle; and</text>
</item><item commented="no" id="id72ACACAD27AA4B3E93E068207269374C"><enum>(bb)</enum><text>satisfy the information objectives of such interface relating to security and privacy throughout the system development lifecycle.</text>
</item></subclause></clause><clause commented="no" id="idAF26AF2A1D2F46379BF79B9DD047762C"><enum>(ii)</enum><header>Definitions</header><text>In this subparagraph:</text> <subclause commented="no" id="id6BB89927976A44D5A045F90D126B44A4"><enum>(I)</enum><header>Electronic protected health information</header><text>The term <term>electronic protected health information</term> has the meaning given that term in section 160.103 of title 45, Code of Federal Regulations, as in effect on the date of the enactment of this Act.</text>
</subclause><subclause commented="no" id="idBC6547990ADC464FBCC32220859E9A71"><enum>(II)</enum><header>Secure development requirements</header><text>The term <term>secure development requirements</term> means, with respect to the electronic interface established under subparagraph (A), activities that are required to be completed during the system development lifecycle of such interface, such as secure coding principles and test methodologies.</text>
</subclause></clause></subparagraph></paragraph><paragraph id="id2e8179e29f8648f6a7d8815616bc789c"><enum>(3)</enum><header>Analysis of available technology for electronic interface</header>
<subparagraph id="idA336A8C957984A3FAD68DACF5C728D66"><enum>(A)</enum><header>In general</header><text>Not later than January 1, 2017, or before entering into a contract to procure or design and build the electronic interface described in paragraph (2) or making a decision to internally design and build such electronic interface, whichever occurs first, the Secretary shall—</text>
<clause id="idA780DDE832EA4FE68C651E32140DEA3C"><enum>(i)</enum><text>conduct an analysis of commercially available technology that may satisfy the requirements of such electronic interface set forth in such paragraph; and</text>
</clause><clause id="idFDA8E0675EF9411786EE719E247EC227"><enum>(ii)</enum><text>submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report setting forth such analysis.</text>
</clause></subparagraph><subparagraph id="idBB1F6A49B51B472B8B366EF84C0AADFD"><enum>(B)</enum><header>Elements</header><text>The report required under subparagraph (A)(ii) shall include the following:</text> <clause id="idbbd86a311f934663aa73112698295eb6"><enum>(i)</enum><text>An evaluation of commercially available systems that may satisfy the requirements of paragraph (2).</text>
</clause><clause id="id625284eaf0cd4270aa137a2950d83f30"><enum>(ii)</enum><text>The estimated cost of procuring a commercially available system if a suitable commercially available system exists.</text>
</clause><clause id="id01611cdee49c44e5b4ed3ad3088e27db"><enum>(iii)</enum><text>If no suitable commercially available system exists, an assessment of the feasibility of modifying a commercially available system to meet the requirements of paragraph (2), including the estimated cost associated with such modifications.</text>
</clause><clause id="id32f1124b0e3941329596d49d4639a39f"><enum>(iv)</enum><text>If no suitable commercially available system exists and modifying a commercially available system is not feasible, an assessment of the estimated cost and time that would be required to contract with a commercial entity to design and build an electronic interface that meets the requirements of paragraph (2).</text>
</clause><clause id="id41d84081354c4bd18da181264bc36f35"><enum>(v)</enum><text>If the Secretary determines that the Department has the capabilities required to design and build an electronic interface that meets the requirements of paragraph (2), an assessment of the estimated cost and time that would be required to design and build such electronic interface.</text>
</clause><clause id="idcf0b76f3770049d6a9e1d6db0cbac5a6"><enum>(vi)</enum><text>A description of the decision of the Secretary regarding how the Department plans to establish the electronic interface required under paragraph (2) and the justification of the Secretary for such decision.</text>
</clause></subparagraph></paragraph><paragraph id="id28a306d3a7684dde971eaa58ca6a2c18"><enum>(4)</enum><header>Limitation on use of amounts</header><text>The Secretary may not spend any amounts to procure or design and build the electronic interface described in paragraph (2) until the date that is 60 days after the date on which the Secretary submits the report required under paragraph (3)(A)(iii).</text>
</paragraph></subsection></section><section id="idb5a68723d8a64be59ff0f0d2077d29a3"><enum>104.</enum><header>Termination of certain provisions authorizing care to veterans through non-Department of Veterans
Affairs providers</header>
<subsection id="id91676048b3f349828d4ea57f9551bd57"><enum>(a)</enum><header>Termination of authority To contract for care in non-Department facilities</header>
<paragraph id="id396D0325513A4CFA82DB83BBF92D9472"><enum>(1)</enum><header>In general</header><text>Section 1703 of title 38, United States Code, is amended by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="id5BAA8F70FEDC48078F765150786546F5" style="OLC">
<subsection id="id20bccc3396ed446789fa655d47f9d19e"><enum>(e)</enum><text>The authority of the Secretary under this section terminates on December 31, 2017.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block> </paragraph><paragraph id="idF8367FAB9F424ED6BFA9F1CBDD379E51"><enum>(2)</enum><header>Conforming amendments</header> <subparagraph id="id4E4E627FDC8642BCAD7B141BA377CAD1"><enum>(A)</enum><header>In general</header> <clause id="id5a0b6b62c7cd4a45817dc95f399fdf60"><enum>(i)</enum><header>Dental care</header><text>Section 1712(a) of such title is amended—</text>
<subclause id="id7E46D32F8E47487CACE1AB32B8C74848"><enum>(I)</enum><text>in paragraph (3), by striking <quote>under clause (1), (2), or (5) of section 1703(a) of this title</quote> and inserting <quote>under the Veterans Choice Program (as defined in section 1703B(e) of this title)</quote>; and</text> </subclause><subclause id="id8F6BAB1B75F34DA79D593E0A0E86E345"><enum>(II)</enum><text>in paragraph (4)(A), in the first sentence—</text>
<item id="id1D45F5C7EAD540BFBB5EB3AD73FC66AB"><enum>(aa)</enum><text>by striking <quote>and section 1703 of this title</quote> and inserting <quote>and the Veterans Choice Program (as defined in section 1703B(e) of this title)</quote>; and</text> </item><item id="idFF9F6E76B22F42C9BAD4712CF2AD3C5A"><enum>(bb)</enum><text>by striking <quote>in section 1703 of this title</quote> and inserting <quote>under the Veterans Choice Program</quote>.</text>
</item></subclause></clause><clause id="idb68427c2cf8342b48bbd4000bb98d273"><enum>(ii)</enum><header>Readjustment counseling</header><text>Section 1712A(e)(1) of such title is amended by striking <quote>(under sections 1703(a)(2) and 1710(a)(1)(B) of this title)</quote> and inserting <quote>(under the Veterans Choice Program (as defined in section 1703B(e) of this title) and section 1710(a)(1)(B) of this title)</quote>.</text>
</clause><clause id="id0b8c6d66e96742d29810f39dc295433b"><enum>(iii)</enum><header>Death in Department facility</header><text>Section 2303(a)(2)(B)(i) of such title is amended by striking <quote>in accordance with section 1703</quote> and inserting <quote>under the Veterans Choice Program (as defined in section 1703B(e) of this title)</quote>.</text> </clause><clause id="idA694A4B2B47741A7ADAFB8B7682727ED"><enum>(iv)</enum><header>Medicare provider agreements</header><text>Section 1866(a)(1)(L) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)(1)(L)</external-xref>) is amended—</text>
<subclause id="idF6C32682CDCA430EA5F35C12BE0925B7"><enum>(I)</enum><text>by striking <quote>under section 1703 of title 38</quote> and inserting <quote>under the Veterans Choice Program (as defined in section 1703B(e) of title 38, United States Code)</quote>; and</text> </subclause><subclause id="id211053C3A8D04357AB8947CFF579D79D"><enum>(II)</enum><text>by striking <quote>such section</quote> and inserting <quote>such program</quote>.</text>
</subclause></clause></subparagraph><subparagraph id="id43b647195d37445a9e8017308523fef9"><enum>(B)</enum><header>Effective date</header><text>The amendments made by subparagraph (A) shall take effect on January 1, 2018.</text> </subparagraph></paragraph></subsection><subsection id="id66FA6C2F98294EC3888D40964637FD8E"><enum>(b)</enum><header>Repeal of authority To contract for scarce medical specialists</header> <paragraph id="idAD6C60FC381D4645B676C613E2C4B875"><enum>(1)</enum><header>In general</header><text>Section 7409 of such title is repealed.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="id3EE7D8863CD1415896DEEB2160851E3C"><enum>(2)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 74 of such title is amended by striking the item relating to section 7409.</text>
</paragraph></subsection></section><enum>II</enum><header>Health care administrative matters</header>
<section id="idfb5e4c62f18845b88d5220fff67d4642"><enum>201.</enum><header>Authorization of agreements between the Department of Veterans Affairs and non-Department providers</header>
<subsection id="id25d1cdd1dff44cb6aa116bfe3fe1c800"><enum>(a)</enum><header>In general</header><text>Subchapter I of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, as amended by section 103(a)(1), is further amended by inserting after section 1703B the following new section:</text>
<quoted-block display-inline="no-display-inline" id="id9CFC7D61EDB447E8951A047D9E749578" style="USC">
<section id="ide89384570eea4b22a134b29e82fe6be2"><enum>1703C.</enum><header>Veterans Care Agreements</header>
<subsection id="id82f615fb6fe441869d9ac981c773d447"><enum>(a)</enum><header>Agreements To furnish care</header><paragraph commented="no" display-inline="yes-display-inline" id="idA5CF5AF8E3F84ADB9E7E89B47E122728"><enum>(1)</enum><text>In addition to the authority of the Secretary under this chapter to furnish hospital care, medical services, and extended care at facilities of the Department and under contracts or sharing agreements entered into under authorities other than this section, the Secretary may furnish hospital care, medical services, and extended care through the use of agreements entered into under this section. An agreement entered into under this section may be referred to as a <quote>Veterans Care Agreement</quote>.</text>
</paragraph><paragraph id="idAA6012948B424D8B9248A9DCF7A728BA" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id5DDD3E3253E64352B6BB245E690C9A60"><enum>(A)</enum><text>The Secretary may enter into agreements under this section with eligible providers that are certified under subsection (d) if the Secretary is not feasibly able to furnish care or services described in paragraph (1) at facilities of the Department.</text>
</subparagraph><subparagraph id="id309E55942A5B44C7B54F89588D2C603C" indent="up1"><enum>(B)</enum><text>The Secretary is not feasibly able to furnish care or services described in paragraph (1) at facilities of the Department if the Secretary determines that the medical condition of the veteran, the travel involved, the nature of the care or services required, or a combination of those factors make the use of facilities of the Department impracticable or inadvisable.</text>
</subparagraph></paragraph><paragraph id="ida91affd129274554bd3286569b49f45e" indent="up1"><enum>(3)</enum><text>An eligible provider, at its discretion, may opt to enter into an agreement under this section instead of a contract or sharing agreement under authorities other than this section.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id27F80AB533794A80BB504EF98A4F3192"><enum>(b)</enum><header>Receipt of care</header><paragraph commented="no" display-inline="yes-display-inline" id="id9C0483FC2447475DAD072547557CBC16"><enum>(1)</enum><text>Eligibility of a veteran under this section for care or services described in paragraph (1) shall be determined as if such care or services were furnished in a facility of the Department and provisions of this title applicable to veterans receiving such care or services in a facility of the Department shall apply to veterans receiving such care or services under this section.</text>
</paragraph><paragraph id="id5a79d1cbf76d49089173f3b113c334a6" indent="up1"><enum>(2)</enum><text>In carrying out this section, the Secretary—</text> <subparagraph id="id6560D838657A48528EFAD76B39CEB611"><enum>(A)</enum><text>may not direct veterans seeking care or services described in paragraph (1) to health care providers that have entered into contracts or sharing agreements under authorities other than this section; and</text>
</subparagraph><subparagraph id="id1F906F0EEA7B45B1A46BFBD21CFB80AF"><enum>(B)</enum><text>shall ensure that veterans have the option to determine whether to receive such care or services from a health care provider described in subparagraph (A) or an eligible provider that has entered into an agreement under this section.</text>
</subparagraph></paragraph></subsection><subsection id="id1b397007031249b0969bc4da60ab3fa1"><enum>(c)</enum><header>Eligible providers</header><text>For purposes of this section, an eligible provider is one of the following:</text> <paragraph id="idc59d457d3ddb4a35b419610ab2e5642a"><enum>(1)</enum><text>A provider of services that has enrolled and entered into a provider agreement under section 1866(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(a)</external-xref>).</text>
</paragraph><paragraph id="idEAD8097B45A2482EAF7C542A9AF6FA69"><enum>(2)</enum><text>A physician or supplier that has enrolled and entered into a participation agreement under section 1842(h) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395u">42 U.S.C. 1395u(h)</external-xref>).</text>
</paragraph><paragraph id="id8e486664caa44a87882ef30379441dd2"><enum>(3)</enum><text>A provider of items and services receiving payment under a State plan under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) or a waiver of such a plan.</text>
</paragraph><paragraph id="idf98565a7b3f24e799fbd326f72e42980"><enum>(4)</enum><text>A health care provider that is—</text> <subparagraph id="id36FC4C85593A4817BEAD6DD825B96586"><enum>(A)</enum><text>an Aging and Disability Resource Center, an area agency on aging, or a State agency (as defined in section 102 of the Older Americans Act of 1965 (<external-xref legal-doc="usc" parsable-cite="usc/42/3002">42 U.S.C. 3002</external-xref>)); or</text>
</subparagraph><subparagraph id="id50371691863146F4A880E6D599194414"><enum>(B)</enum><text>a center for independent living (as defined in section 702 of the Rehabilitation Act of 1973 (<external-xref legal-doc="usc" parsable-cite="usc/29/796a">29 U.S.C. 796a</external-xref>)).</text>
</subparagraph></paragraph><paragraph id="idDB576582328242D2B3EA2212A2DE1430"><enum>(5)</enum><text>A provider that is located in—</text> <subparagraph id="idD81977748F6740788C805F3E8245081B"><enum>(A)</enum><text>an area that is designated as a health professional shortage area (as defined in section 332 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254e">42 U.S.C. 254e</external-xref>)); or</text>
</subparagraph><subparagraph id="idE8E47ED5F6D44DF38AACFCC4A6B457BB"><enum>(B)</enum><text>a county that is not in a metropolitan statistical area.</text> </subparagraph></paragraph><paragraph id="id4eecc6ae596e4308b2079c8834076c6d"><enum>(6)</enum><text>Such other health care providers as the Secretary considers appropriate for purposes of this section.</text>
</paragraph></subsection><subsection id="id7377beb599c64b5a9cad0fa9fdc64c52"><enum>(d)</enum><header>Certification of eligible providers</header><paragraph commented="no" display-inline="yes-display-inline" id="id42E129168EC143659566B14FD8C45F51"><enum>(1)</enum><text>The Secretary shall establish a process for the certification of eligible providers under this section that shall, at a minimum, set forth the following:</text>
<subparagraph id="idC47BBDC171C9423DA84CCB08C690FB32" indent="up1"><enum>(A)</enum><text>Procedures for the submittal of applications for certification and deadlines for actions taken by the Secretary with respect to such applications.</text>
</subparagraph><subparagraph id="idA0E6907D8C4D4E06835DEB80DD7EB1FF" indent="up1"><enum>(B)</enum><text>Standards and procedures for approval and denial of certification, duration of certification, revocation of certification, and recertification.</text>
</subparagraph><subparagraph id="id17125865FA57408CBEB1E9494B8A4406" indent="up1"><enum>(C)</enum><text>Procedures for assessing eligible providers based on the risk of fraud, waste, and abuse of such providers similar to the level of screening under section 1866(j)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395cc">42 U.S.C. 1395cc(j)(2)(B)</external-xref>) and the standards set forth under section 9.104 of title 48, Code of Federal Regulations, or any successor regulation.</text>
</subparagraph></paragraph><paragraph id="id723F9F96E62045018BCFEDDFF82B36D6" indent="up1"><enum>(2)</enum><text>The Secretary shall deny or revoke certification to an eligible provider under this subsection if the Secretary determines that the eligible provider is currently—</text>
<subparagraph id="idCD54171E2BFD472F86E9036E00B367DE"><enum>(A)</enum><text>excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); or</text>
</subparagraph><subparagraph id="idA8DAE00329384147A23738993E4DD802"><enum>(B)</enum><text>identified as an excluded source on the list maintained in the System for Award Management, or any successor system.</text>
</subparagraph></paragraph></subsection><subsection id="id793f1958c43c4780ae1e7b4bc6cf0739"><enum>(e)</enum><header>Terms of agreements</header><text>Each agreement entered into with an eligible provider under this section shall include provisions requiring the eligible provider to do the following:</text>
<paragraph id="idfb1c92f06af04876bab6b0526f83efe6"><enum>(1)</enum><text>To accept payment for care or services furnished under this section at rates established by the Secretary for purposes of this section, which shall be, to the extent practicable, the rates paid by the United States for such care or services to providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>).</text>
</paragraph><paragraph id="id42c28111ae6c41f1a44fd070c71a5731"><enum>(2)</enum><text>To accept payment under paragraph (1) as payment in full for care or services furnished under this section and to not seek any payment for such care or services from the recipient of such care or services.</text>
</paragraph><paragraph id="idf5c3ea83130d46cba9256b6de886c387"><enum>(3)</enum><text>To furnish under this section only the care or services authorized by the Department under this section unless the eligible provider receives prior written consent from the Department to furnish care or services outside the scope of such authorization.</text>
</paragraph><paragraph id="id7b7aee38c33e4adc88724cf1c138bf95"><enum>(4)</enum><text>To bill the Department for care or services furnished under this section in accordance with a methodology established by the Secretary for purposes of this section.</text>
</paragraph><paragraph id="id67f2edbf92914e0e894efafa9f9f4b5d"><enum>(5)</enum><text>Not to 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 care or services for which payment is made by the Department under this section.</text>
</paragraph><paragraph id="idbb3d49b0c66248ae8c5c2ac38f34633a"><enum>(6)</enum><text>To provide medical records for veterans furnished care or services under this section to the Department in a timeframe and format specified by the Secretary for purposes of this section.</text>
</paragraph><paragraph id="id83fe8e54d9e342eb95562653f9f3705f"><enum>(7)</enum><text>To meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify for purposes of this section.</text>
</paragraph></subsection><subsection id="ida306496402ce4551b2d8b9cc6aa4da40"><enum>(f)</enum><header>Termination of agreements</header><paragraph commented="no" display-inline="yes-display-inline" id="idE40F926AAD404D30AE10CF281BCD8236"><enum>(1)</enum><text>An eligible provider may terminate an agreement with the Secretary under this section at such time and upon such notice to the Secretary as the Secretary may specify for purposes of this section.</text>
</paragraph><paragraph id="idC5F66D923F61435DBA9D2173DD33B698" indent="up1"><enum>(2)</enum><text>The Secretary may terminate an agreement with an eligible provider under this section at such time and upon such notice to the eligible provider as the Secretary may specify for purposes of this section, if the Secretary—</text>
<subparagraph id="id2AADBC6C425C44D99C86F8D73A7894D0"><enum>(A)</enum><text>determines that the eligible provider failed to comply substantially with the provisions of the agreement or with the provisions of this section and the regulations prescribed thereunder;</text>
</subparagraph><subparagraph id="id063A9792C6604A11863AD6FAB4B45E05"><enum>(B)</enum><text>determines that the eligible provider is—</text> <clause id="id84A9A4707652497E8B986937E608AFC4"><enum>(i)</enum><text>excluded from participation in a Federal health care program (as defined in section 1128B(f) of the Social Security Act (42 U.S.C. 1320a–7b(f))) under section 1128 or 1128A of the Social Security Act (42 U.S.C. 1320a–7 and 1320a–7a); or</text>
</clause><clause id="id0EEC6773CA484871A013523A5E925C14"><enum>(ii)</enum><text>identified as an excluded source on the list maintained in the System for Award Management, or any successor system;</text>
</clause></subparagraph><subparagraph id="id24A6D592DD1E4FB984FCA0D77BF83E32"><enum>(C)</enum><text>ascertains that the eligible provider has been convicted of a felony or other serious offense under Federal or State law and determines that the continued participation of the eligible provider would be detrimental to the best interests of veterans or the Department; or</text>
</subparagraph><subparagraph id="id2591E4B6839F43CA973EA014C00C60F2"><enum>(D)</enum><text>determines that it is reasonable to terminate the agreement based on the health care needs of a veteran or veterans.</text>
</subparagraph></paragraph></subsection><subsection id="id66F16CDBB7A74B43A42EBBE321080DC4"><enum>(g)</enum><header>Periodic review of certain agreements</header><paragraph commented="no" display-inline="yes-display-inline" id="id20D473A7573540BBAFEC221C790BC852"><enum>(1)</enum><text>Not less frequently than once every two years, the Secretary shall review each Veterans Care Agreement of material size entered into during the two-year period preceding the review to determine whether it is feasible and advisable to furnish the hospital care, medical services, or extended care furnished under such agreement at facilities of the Department or through contracts or sharing agreements entered into under authorities other than this section.</text>
</paragraph><paragraph id="idEADE74FC3C0A42F0A0652E270696B30F" indent="up1"><enum>(2)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="id2A6B68B178874C9AB2001EAAEF933122"><enum>(A)</enum><text>Subject to subparagraph (B), a Veterans Care Agreement is of material size as determined by the Secretary for purposes of this section.</text>
</subparagraph><subparagraph id="id66C7AE78D8DC49A2A51D3DAC4E6B91A3" indent="up1"><enum>(B)</enum><text>A Veterans Care Agreement entered into after September 30, 2016, for the purchase of extended care services is of material size if the purchase of such services under the agreement exceeds $1,000,000 annually. The Secretary may adjust such amount to account for changes in the cost of health care based upon recognized health care market surveys and other available data and shall publish any such adjustments in the Federal Register.</text>
</subparagraph></paragraph></subsection><subsection id="id02d6b8bb19664b3c819040af6a8907a9"><enum>(h)</enum><header>Treatment of certain laws</header><paragraph commented="no" display-inline="yes-display-inline" id="idCFCC3E3604D64CE8ADD49BC4B5F16BBC"><enum>(1)</enum><text>An agreement under this section may be entered into without regard to any law that would require the Secretary to use competitive procedures in selecting the party with which to enter into the agreement.</text>
</paragraph><paragraph id="idB63F70DECCBD47EEB1A15D27E0354577" indent="up1"><enum>(2)</enum><text>An eligible provider that enters into an agreement under this section may not be treated as a Federal contractor or subcontractor by the Office of Federal Contract Compliance Programs of the Department of Labor by virtue of furnishing hospital care, medical services, or extended care under that agreement.</text>
</paragraph><paragraph id="id163565353B874737AE1520852BB6208E" indent="up1"><enum>(3)</enum><subparagraph commented="no" display-inline="yes-display-inline" id="idFFBB7DC273494A26857F32BE5B91D3AF"><enum>(A)</enum><text>Except as provided in subparagraph (B) and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law that an eligible provider described in subsection (b)(1), (b)(2), or (b)(3) is not subject to under the original Medicare fee-for-service program under parts A and B of title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) or the Medicaid program under title XIX of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>).</text>
</subparagraph><subparagraph id="id65dec1ed1f9747218a058dd884635d54" indent="up1"><enum>(B)</enum><text>The exclusion under subparagraph (A) does not apply to laws regarding integrity, ethics, fraud, or that subject a person to civil or criminal penalties.</text>
</subparagraph></paragraph><paragraph id="idebde5d2bca53412f8be2be89b418bf67" indent="up1"><enum>(4)</enum><text>Title VII of the Civil Rights Act of 1964 (<external-xref legal-doc="usc" parsable-cite="usc/42/2000e">42 U.S.C. 2000e et seq.</external-xref>) shall apply with respect to an eligible provider that enters into an agreement under this section to the same extent as such title applies with respect to the eligible provider in providing care or services through an agreement or arrangement other than under this section.</text>
</paragraph></subsection><subsection id="id0f69d95297424c88a8f80dfbddb822bf"><enum>(i)</enum><header>Monitoring of quality of care</header><text>The Secretary shall establish a system or systems, consistent with survey and certification procedures used by the Centers for Medicare & Medicaid Services and State survey agencies to the extent practicable—</text>
<paragraph id="idD6187A507F74469888B3B9402F9539F3"><enum>(1)</enum><text>to monitor the quality of care and services furnished to veterans under this section; and</text> </paragraph><paragraph id="idDBE9B60D2A174B74B2D0718E9D34F7CA"><enum>(2)</enum><text>to assess the quality of care and services furnished by an eligible provider under this section for purposes of determining whether to renew an agreement under this section with the eligible provider.</text>
</paragraph></subsection><subsection id="idd2a0948bcc79464b8a098ebd47871e5b"><enum>(j)</enum><header>Dispute resolution</header><text>The Secretary shall establish administrative procedures for eligible providers with which the Secretary has entered into an agreement under this section to present any dispute arising under or related to the agreement.</text>
</subsection></section><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection><subsection id="id9cfa566a0bb34a2895e54515e4b21341"><enum>(b)</enum><header>Regulations</header><text>The Secretary of Veterans Affairs shall prescribe an interim final rule to carry out section 1703C of such title, as added by subsection (a), not later than one year after the date of the enactment of this Act.</text>
</subsection><subsection id="iddeb24b40e17c43d98815bcf696ea3d81"><enum>(c)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title, as amended by section 103(a)(2), is further amended by inserting after the item related to section 1703B the following new item:</text>
<quoted-block display-inline="no-display-inline" id="id231F46E4F6B14596A5F13D6A5245A906" style="OLC"><toc><toc-entry bold="off" level="section">1703C. Veterans Care Agreements.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="idb719bc67c76949a5bc1e3b57eeb62598"><enum>202.</enum><header>Reimbursement of certain entities for emergency medical transportation</header>
<subsection id="idF93079A486264924BA72126E319C9B55"><enum>(a)</enum><header>In general</header><text>Subchapter III of <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/17">chapter 17</external-xref> of title 38, United States Code, is amended by inserting after <external-xref legal-doc="usc" parsable-cite="usc/38/1725">section 1725</external-xref> the following new section:</text>
<quoted-block display-inline="no-display-inline" id="idBBB45BB7D46544F3A9114DC3B254DF67" style="USC">
<section id="idD469D716C789426D8671444434B90A69"><enum>1725A.</enum><header>Reimbursement of certain entities for emergency medical transportation</header>
<subsection id="id2ac765dd2c3e4c34abf72d17f6b785d8"><enum>(a)</enum><header>In general</header><text>Notwithstanding any other provision of law, the Secretary shall reimburse an ambulance provider or any other entity that provides transportation to a veteran described in section 1725(b) of this title for the purpose of receiving emergency treatment at a non-Department facility the cost of such transportation.</text>
</subsection><subsection id="id6568F38FABD84497978929D7BD990CDD"><enum>(b)</enum><header>Service connection</header><paragraph commented="no" display-inline="yes-display-inline" id="id36447FFE98A94CE1ABEDDFEF63125AA4"><enum>(1)</enum><text>The Secretary shall reimburse an ambulance provider or any other entity under subsection (a) regardless of whether the underlying medical condition for which the veteran is seeking emergency treatment is in connection with a service-connected disability.</text>
</paragraph><paragraph id="id4769833356584CDEA68AE5A42A91E846" indent="up1"><enum>(2)</enum><text>If the Secretary determines that the underlying medical condition for which the veteran receives emergency treatment is not in connection with a service-connected disability, the Secretary shall recoup the cost of transportation paid under subsection (a) in connection with such emergency treatment from any health-plan contract under which the veteran is covered.</text>
</paragraph></subsection><subsection id="id155AE1489A9B465082260081352A0038"><enum>(c)</enum><header>Timing</header><text>Reimbursement under subsection (a) shall be made not later than 30 days after receiving a request for reimbursement under such subsection.</text>
</subsection><subsection id="id297D2647961A407CAC4FA3EAD1CF585C"><enum>(d)</enum><header>Definitions</header><text>In this section, the terms <term>emergency treatment</term> and <term>health-plan contract</term> have the meanings given those terms in section 1725(f) of this title.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </subsection><subsection id="id2484CBA635384989A1C653476A33E287"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item related to section 1725 the following new item:</text>
<quoted-block display-inline="no-display-inline" id="id541C04BB349B43E7868A9DB36786C988" style="OLC"><toc><toc-entry bold="off" level="section">1725A. Reimbursement for emergency medical transportation.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="idf3a2f36423be4f02a73f0eb812c4185b"><enum>203.</enum><header>Requirement that Department of Veterans Affairs collect health-plan contract information from
veterans</header>
<subsection id="idb8c7573a35b0489b9b789687eeffc610"><enum>(a)</enum><header>In general</header><text>Subchapter I of chapter 17 is amended by inserting after section 1705 the following new section:</text> <quoted-block display-inline="no-display-inline" id="id5c17911036454092b2e10ef69d5f617f" style="USC"> <section id="id921b1987ec8c4ff9a0973133779e45e4"><enum>1705A.</enum><header>Management of health care: information regarding health-plan contracts</header> <subsection id="id07e6b06aea904867bfa4dfa068de2abe"><enum>(a)</enum><header>In general</header><paragraph commented="no" display-inline="yes-display-inline" id="idC774D7F3FE844C25A358C5C40D2EA9F9"><enum>(1)</enum><text>Any individual who seeks hospital care or medical services under this chapter shall provide to the Secretary such current information as the Secretary may require to identify any health-plan contract under which such individual is covered.</text>
</paragraph><paragraph id="idF1EE316D3BA7447FB49DE60F6A58D17F" indent="up1"><enum>(2)</enum><text>The information required to be provided to the Secretary under paragraph (1) with respect to a health-plan contract shall include, as applicable, the following:</text>
<subparagraph id="id300C2E5D341343909BCBB3A034C20038"><enum>(A)</enum><text>The name of the entity providing coverage under the health-plan contract.</text> </subparagraph><subparagraph id="id9AEAA57E795C4229807314985A6FA642"><enum>(B)</enum><text>If coverage under the health-plan contract is in the name of an individual other than the individual required to provide information under this section, the name of the policy holder of the health-plan contract.</text>
</subparagraph><subparagraph id="id9B49D56B8BE641FEB055C7931B6D67D0"><enum>(C)</enum><text>The identification number for the health-plan contract.</text> </subparagraph><subparagraph id="id11CCD3B6B2554475A602DB851CE28C1B"><enum>(D)</enum><text>The group code for the health-plan contract.</text>
</subparagraph></paragraph></subsection><subsection id="idD2C2C8F799A34FBFAA07ABD4AEF5BFBD"><enum>(b)</enum><header>Action To collect information</header><text>The Secretary may take such action as the Secretary considers appropriate to collect the information required under subsection (a).</text>
</subsection><subsection id="id14d550bdac42444d8cb49c8701fcaa17"><enum>(c)</enum><header>Effect on services from Department</header><text>The Secretary may not deny any services under this chapter to an individual solely due to the fact that the individual fails to provide information required under subsection (a).</text>
</subsection><subsection id="id3caa3fb041804fe9aec61502cb57de4a"><enum>(d)</enum><header>Health-Plan contract defined</header><text>In this section, the term <term>health-plan contract</term> has the meaning given that term in section 1725(f) of this title.</text></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block> </subsection><subsection id="id8a1b9dc4cb464acaaa6f8a776e40da4d"><enum>(b)</enum><header>Clerical amendment</header><text>The table of sections at the beginning of chapter 17 of such title is amended by inserting after the item relating to section 1705 the following new item:</text>
<quoted-block id="id177f31a4-d7f3-4e33-8423-234cc6a5d5ee" style="USC"><toc><toc-entry idref="id921b1987ec8c4ff9a0973133779e45e4" level="section">1705A. Management of health care: information regarding health-plan contracts.</toc-entry></toc><after-quoted-block>.</after-quoted-block></quoted-block>
</subsection></section><section id="idc613675ff66e44bcbea0982c6c4070fe"><enum>204.</enum><header>Requirement for advance appropriations for the Veterans Choice Program account of the Department of
Veterans Affairs</header>
<subsection id="id29a1d081a241435d8c20316d979b4e7b"><enum>(a)</enum><header>In general</header><text>Section 117(c) of title 38, United States Code, is amended by adding at the end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="id43EF29259F2D48759095BEB33FB10356" style="OLC">
<paragraph id="id6b5dc72ab3d44c689276849d5ab43afa"><enum>(7)</enum><text>Veterans Health Administration, Veterans Choice Program.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </subsection><subsection id="idf292cd4bb9994c46864a32e7b85b13a7"><enum>(b)</enum><header>Conforming amendment</header><text>Section 1105(a)(37) of title 31, United States Code, is amended by adding at the end the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idFD061FCC37A44954837446C3F792ED00" style="OLC">
<subparagraph id="id0c4bfcb1fd8342129fdb01bf1483eaf9"><enum>(G)</enum><text>Veterans Health Administration, Veterans Choice Program.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block> </subsection><subsection commented="no" display-inline="no-display-inline" id="ida70cd83dee2f40728fc8566889a1323b"><enum>(c)</enum><header>Applicability</header><text>The amendments made by this section shall apply to fiscal years beginning on and after October 1, 2016.</text>
</subsection></section><section id="H5A88E9FD18624F23A1CFBB8A32F4ED05">
<enum>205.</enum>
<header>Reauthorization of pilot program of enhanced contract care authority for health
care
needs of veterans</header>
<text display-inline="no-display-inline">Paragraph (3) of section 403(a) of the Veterans’ Mental Health and Other Care Improvements Act of 2008 (<external-xref legal-doc="public-law" parsable-cite="pl/110/387">Public Law 110–387</external-xref>; <external-xref legal-doc="usc" parsable-cite="usc/38/1703">38 U.S.C. 1703</external-xref> note) is amended to read as follows:</text>
<quoted-block display-inline="no-display-inline" id="idFE13F1EDB14B4140A3F8325DA70D0E8A" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="ida4365e6e412c46d4b661a65855782905"><enum>(3)</enum><header>Termination</header><text>The Secretary may not provide covered health services under the pilot program after August 7, 2019.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block> </section><enum>III</enum><header>Other veterans matters</header> <section id="id05A5CFDAA4F74755BAF0375DABD8DE4E"><enum>301.</enum><header>Timeframe for payment of disability compensation for victims of contaminated water at Camp Lejeune, North Carolina, when the Secretary of Veterans Affairs establishes a presumption of service connection</header> <subsection id="idBF1DC03C8351485BA5030771B852B399"><enum>(a)</enum><header>In general</header><text>Except as provided in subsection (b), in any case in which the Secretary of Veterans Affairs establishes a presumption of service connection for purposes of compensation under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/38/11">chapter 11</external-xref> of title 38, United States Code, for an illness or condition incurred by an individual described in section 1710(e)(1)(F) of such title, the Secretary shall commence, not later than 90 days after the date on which the Secretary established such presumption, payment of compensation under such chapter to the individuals who are entitled to such compensation under such chapter by virtue of such presumption.</text>
</subsection><subsection commented="no" display-inline="no-display-inline" id="idD0B26CFE47D6479889F962E0D4CE2F2B"><enum>(b)</enum><header>Presumptions established before date of enactment</header><text>In a case in which the Secretary established a presumption as described in subsection (a) before the date of the enactment of this Act, the Secretary shall commence payment as described in such subsection not later than the date that is 90 days after the date of the enactment of this Act.</text></subsection></section>