[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4591 Introduced in House (IH)]

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114th CONGRESS
  2d Session
                                H. R. 4591

 To amend title 38, United States Code, to authorize the Secretary of 
  Veterans Affairs to enter into agreements with certain health care 
providers to furnish hospital care, medical services, and extended care 
                              to veterans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 23, 2016

Mr. Miller of Florida introduced the following bill; which was referred 
                 to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend title 38, United States Code, to authorize the Secretary of 
  Veterans Affairs to enter into agreements with certain health care 
providers to furnish hospital care, medical services, and extended care 
                              to veterans.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Department of Veterans Affairs 
Purchased Health Care Streamlining and Modernization Act''.

SEC. 2. AGREEMENTS.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is amended by inserting after section 1703 the following 
new section:
``Sec. 1703A. Veterans Care Agreements with certain health care 
              providers
    ``(a) Veterans Care Agreements.--(1) In addition to furnishing 
hospital care, medical services, or extended care under this chapter at 
facilities of the Department or under contracts or sharing agreements 
entered into pursuant to provisions of law other than this section, the 
Secretary may furnish such care and services to eligible veterans 
through the use of agreements entered into under this section by the 
Secretary with eligible providers.
    ``(2) The Secretary may enter into Veterans Care Agreements under 
this section with eligible providers to furnish hospital care, medical 
services, and extended care to veterans whom the Secretary determines 
that furnishing such care and services at facilities of the Department 
or under contracts or sharing agreements under provisions of law other 
than this section is impracticable or inadvisable because of the 
medical condition of the veteran, the travel involved, or the nature of 
the care or services required, or a combination of such factors.
    ``(b) Veteran Eligibility.--Eligibility of a veteran for care and 
services under this section 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 and services 
in a facility of the Department shall apply to veterans receiving care 
and services under this section.
    ``(c) Provider Eligibility.--Subject to the certification process 
pursuant to subsection (d)(1), a provider of hospital care, medical 
services, or extended care is eligible to enter into a Veterans Care 
Agreement under this section if the Secretary determines that the 
provider meets each of the following criteria:
            ``(1) The gross annual revenue of the provider in the year 
        preceding the year in which the provider enters into the 
        Veterans Care Agreement does not exceed $11,000,000 (as 
        adjusted in a manner similar to amounts adjusted pursuant to 
        section 5312 of this title).
            ``(2) The provider does not otherwise provide such care or 
        services to patients pursuant to a contract entered into with a 
        department or agency of the Federal Government.
            ``(3) The provider is--
                    ``(A) a provider of services that has enrolled and 
                entered into a provider agreement under section 1866(a) 
                of the Social Security Act (42 U.S.C. 1395cc(a));
                    ``(B) a physician or supplier that has enrolled and 
                entered into a participation agreement under section 
                1842(h) of such Act (42 U.S.C. 1395u(h));
                    ``(C) a provider of items and services receiving 
                payment under a State plan under title XIX of such Act 
                (42 U.S.C. 1396 et seq.) or a waiver of such a plan;
                    ``(D) 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 (42 
                U.S.C. 3002)); or
                    ``(E) a center for independent living (as defined 
                in section 702 of the Rehabilitation Act of 1973 (29 
                U.S.C. 796a)).
            ``(4) Any additional criteria determined appropriate by the 
        Secretary.
    ``(d) Provider Certification.--(1) The Secretary shall establish a 
process for the certification of eligible providers to enter into 
Veterans Care Agreements under this section that shall, at a minimum, 
set forth the following:
            ``(A) Procedures for the submission of applications for 
        certification and deadlines for actions taken by the Secretary 
        with respect to such applications.
            ``(B) Standards and procedures for the approval and denial 
        of certifications and the revocation of certifications.
            ``(C) 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 (42 U.S.C. 1395(j)(2)(B)) and the standards 
        set forth under section 9.104 of title 48, Code of Federal 
        Regulations, or any successor regulation.
            ``(D) Requirement for denial or revocation of certification 
        if the Secretary determines that the otherwise eligible 
        provider is--
                    ``(i) 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
                    ``(ii) identified as an excluded source on the list 
                maintained in the System for Award Management, or any 
                successor system.
            ``(E) Procedures by which a provider whose certification is 
        denied or revoked under the procedures established under this 
        subsection will be identified as an excluded source on the list 
        maintained in the System for Award Management, or successor 
        system, if the Secretary determines that such exclusion is 
        appropriate.
    ``(2) To the extent practicable, the Secretary shall establish the 
procedures under paragraph (1) in a manner that takes into account any 
certification process administered by another department or agency of 
the Federal Government that an eligible provider has completed by 
reason of being a provider described in any of subparagraphs (A) 
through (E) of subsection (c)(3).
    ``(e) Terms of Agreements.--The Secretary shall ensure that each 
Veterans Care Agreement include provisions requiring the eligible 
provider to do the following:
            ``(1) To accept payment for care and services furnished 
        under this section at rates established by the Secretary for 
        purposes of this section, which shall be, to the extent 
        practicable--
                    ``(A) the rates paid by the United States for such 
                care to providers of services and suppliers under the 
                Medicare program under title XVIII of the Social 
                Security Act (42 U.S.C. 1395 et seq.);
                    ``(B) the rates paid by the United States pursuant 
                to the Alaska Fee Schedule of the Department of 
                Veterans Affairs;
                    ``(C) the rates paid by the United States pursuant 
                to an All-Payer Model Agreement under the Social 
                Security Act; or
                    ``(D) the rates paid by the United States in a 
                highly rural area pursuant to section 
                101(d)(2)(B)(ii)(I) of the Veterans Access, Choice, and 
                Accountability Act of 2014 (38 U.S.C. 1701 note).
            ``(2) To accept payment under paragraph (1) as payment in 
        full for care and services furnished under this section and to 
        not seek any payment for such care and services from the 
        recipient of such care.
            ``(3) To furnish under this section only the care and 
        services authorized by the Department under this section unless 
        the eligible provider receives prior written consent from the 
        Department to furnish care and services outside the scope of 
        such authorization.
            ``(4) To bill the Department for care and services 
        furnished under this section in accordance with a methodology 
        established by the Secretary for purposes of this section.
            ``(5) 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.
            ``(6) To provide medical records for veterans furnished 
        care and services under this section to the Department in a 
        timeframe and format specified by the Secretary for purposes of 
        this section, except the Secretary may not require that any 
        payment by the Secretary to the eligible provider be contingent 
        on such provision of medical records.
            ``(7) To meet other such terms and conditions, including 
        quality of care assurance standards, as the Secretary may 
        specify for purposes of this section.
    ``(f) Exclusion of Certain Federal Contracting Provisions.--(1) 
Notwithstanding any other provision of law, the Secretary may enter 
into a Veterans Care Agreement using procedures other than competitive 
procedures.
    ``(2)(A) Except as provided in subparagraph (B) and unless 
otherwise provided in this section, an eligible provider that enters 
into a Veterans Care Agreement under this section is not subject to, in 
the carrying out of the agreement, any provision of law that providers 
of services and suppliers under the original Medicare fee-for-service 
program under parts A and B of title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) or the Medicaid program under title XIX of 
such Act (42 U.S.C. 1396 et seq.) are not subject to.
    ``(B) In addition to the provisions of laws covered by subparagraph 
(A), an eligible provider shall be subject to the following provisions 
of law:
            ``(i) Any applicable law regarding integrity, ethics, or 
        fraud, or that subject a person to civil or criminal penalties.
            ``(ii) Section 431 of title 18.
            ``(iii) Section 1352 of title 31, except for the filing 
        requirements under subsection (b) of such section.
            ``(iv) Section 4705 or 4712 of title 41, and any other 
        applicable law regarding the protection of whistleblowers.
            ``(v) Section 4706(d) of title 41.
            ``(vi) Title VII of the Civil Rights Act of 1964 (42 U.S.C. 
        2000e et seq.) 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 a Veterans 
        Care Agreement.
    ``(C) An eligible provider that receives a payment from the Federal 
Government pursuant to a Veterans Care Agreement shall not be treated 
as a Federal contractor or subcontractor by the Office of Federal 
Contract Compliance Programs of the Department of Labor based on the 
work performed or actions taken by such eligible provider that resulted 
in the receipt of such payments.
    ``(g) Termination of Veterans Care Agreement.--(1) An eligible 
provider may terminate a Veterans Care 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.
    ``(2) The Secretary may terminate a Veterans Care 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 the purposes 
of this section, if the Secretary--
            ``(A) determines that the eligible provider failed to 
        comply with the provisions of the agreement or this section or 
        other applicable provision of law;
            ``(B) makes a revocation pursuant to subsection (d)(1)(4);
            ``(C) 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 of the Department; or
            ``(D) determines that it is reasonable to terminate the 
        agreement based on the health care needs of veterans.
    ``(h) Duration; Mandatory Reviews.--(1) Each Veterans Care 
Agreement entered into under this section shall be for a two-year 
period unless the Secretary extends the agreement pursuant to paragraph 
(2)(B).
    ``(2)(A) During the 180-day period beginning 540 days after the 
date on which a Veterans Care Agreement is entered into or renewed, the 
Secretary shall review the agreement to determine whether it is 
feasible and advisable to instead furnish the hospital care, medical 
services, or extended care furnished under the agreement at facilities 
of the Department or through contracts or sharing agreements entered 
into under authorities other than this section.
    ``(B) If the Secretary determines under subparagraph (A) that it is 
not feasible and advisable to instead furnish hospital care, medical 
services, or extended care furnished under a Veterans Care Agreement at 
facilities of the Department or through contracts or sharing agreements 
entered into under authorities other than this section, the Secretary--
            ``(i) shall prepare a written memorandum of such 
        determination; and
            ``(ii) may renew such agreement.
    ``(i) Disputes.--(1) The Secretary shall establish administrative 
procedures for eligible providers with which the Secretary has entered 
into a Veterans Care Agreement to present any dispute arising under or 
related to the agreement.
    ``(2) Before using any dispute resolution mechanism under chapter 
71 of title 41 with respect to a dispute arising under a Veterans Care 
Agreement under this section, an eligible provider must first exhaust 
the administrative procedures established by the Secretary under 
paragraph (1).
    ``(j) Annual Reports.--Not later than October 1 of the year 
following the fiscal year in which the Secretary first enters into a 
Veterans Care Agreement, and each year thereafter, the Secretary shall 
submit to the appropriate congressional committees an annual report 
that includes--
            ``(1) a list of all Veterans Care Agreements entered into 
        as of the date of the report; and
            ``(2) summaries of each determination made by the Secretary 
        under subsection (h)(2) during the fiscal year covered by the 
        report.
    ``(k) Quality of Care.--In carrying out this section, the Secretary 
shall use the quality of care standards set forth or used by the 
Centers for Medicare & Medicaid Services.
    ``(l) Delegation.--The Secretary may delegate the authority to 
enter into or terminate a Veterans Care Agreement, or to make a 
determination described in subsection (h)(2), at a level not below the 
Assistant Deputy Under Secretary for Health for Community Care.
    ``(m) Sunset.--The Secretary may not enter into or renew a Veterans 
Care Agreement under this section after the date that is five years 
after the enactment of this Act.
    ``(n) Definitions.--In this section:
            ``(1) The term `appropriate congressional committees' 
        means--
                    ``(A) the Committees on Veterans' Affairs of the 
                House of Representatives and the Senate; and
                    ``(B) the Committees on Appropriations of the House 
                of Representatives and the Senate.
            ``(2) The term `eligible provider' means a provider of 
        hospital care, medical services, or extended care that the 
        Secretary determines is eligible to enter into Veterans Care 
        Agreements under subsection (c).
            ``(3) The term `Veterans Care Agreement' means an agreement 
        entered into by the Secretary with an eligible provider under 
        subsection (a)(1).''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item related 
to section 1703 the following new item:

``1703A. Veterans Care Agreements with certain health care 
                            providers.''.
    (c) Regulations.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Veterans Affairs shall 
prescribe interim final regulations to implement section 1703A of title 
38, United States Code, as added by subsection (a), and publish such 
regulations in the Federal Register.
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