[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 2633 Introduced in Senate (IS)]

<DOC>






114th CONGRESS
  2d Session
                                S. 2633

To improve the ability of the Secretary of Veterans Affairs to provide 
 health care to veterans through non-Department health care providers, 
                        and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 3, 2016

  Mr. Tester (for himself, Mr. Blumenthal, Mr. Bennet, Mr. Udall, Mr. 
Brown, and Ms. Heitkamp) introduced the following bill; which was read 
        twice and referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To improve the ability of the Secretary of Veterans Affairs to provide 
 health care to veterans through non-Department health care providers, 
                        and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Improving Veterans 
Access to Care in the Community Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
   TITLE I--IMPROVEMENT OF ACCESS OF VETERANS TO NON-DEPARTMENT CARE

Sec. 101. Improvement of access of veterans to health care through 
                            establishment of Veterans Choice Program.
Sec. 102. Expansion of reimbursement of veterans for emergency 
                            treatment and urgent care.
Sec. 103. Termination of certain provisions authorizing care to 
                            veterans through non-Department of Veterans 
                            Affairs providers.
           TITLE II--AUTHORITY TO PAY FOR NON-DEPARTMENT CARE

Sec. 201. Authorization of agreements between the Department of 
                            Veterans Affairs and non-Department health 
                            care providers.
Sec. 202. Modification of authority to enter into agreements with State 
                            homes to provide nursing home care.
Sec. 203. Requirement for advance appropriations for the Care in the 
                            Community account of the Department of 
                            Veterans Affairs.
Sec. 204. Annual transfer of amounts within Department of Veterans 
                            Affairs to pay for health care from non-
                            Department providers.
Sec. 205. Elimination of requirement to act as secondary payer for care 
                            relating to non-service-connected 
                            disabilities under Choice Program.
Sec. 206. Authorization of use of certain amounts appropriated to the 
                            Veterans Choice Fund for other non-
                            Department of Veterans Affairs care.
Sec. 207. Modification of process through which Department of Veterans 
                            Affairs records obligations for non-
                            Department care.
                  TITLE III--OTHER HEALTH CARE MATTERS

Sec. 301. Treatment of Department of Veterans Affairs as participating 
                            provider for recovery of costs of certain 
                            medical care.
Sec. 302. Primary care providers for veterans enrolled in patient 
                            enrollment system of Department of Veterans 
                            Affairs.

   TITLE I--IMPROVEMENT OF ACCESS OF VETERANS TO NON-DEPARTMENT CARE

SEC. 101. IMPROVEMENT OF ACCESS OF VETERANS TO HEALTH CARE THROUGH 
              ESTABLISHMENT OF VETERANS CHOICE PROGRAM.

    (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 Choice Program
    ``(a) In General.--(1) The Secretary shall enter into contracts or 
agreements under sections 1703B, 8111, and 8153 of this title with 
eligible providers to furnish hospital care and medical services under 
this chapter to eligible veterans. The provision of hospital care and 
medical services under this section may be referred to as the `Veterans 
Choice Program'.
    ``(2) Hospital care and medical services shall be furnished under 
this section to an eligible veteran at the election of the veteran.
    ``(3)(A) An eligible veteran who makes an election under paragraph 
(2) to receive hospital care or medical services under this section may 
select a provider of such care or services from among the health care 
providers specified in subsection (c)(2) that are accessible to the 
veteran.
    ``(B) The Secretary may not direct an eligible veteran to a 
provider that is not the eligible provider selected by the veteran 
under subparagraph (A).
    ``(b) Eligible Veterans.--A veteran is an eligible veteran for 
purposes of this section if--
            ``(1) the veteran is enrolled in the patient enrollment 
        system of the Department established and operated under section 
        1705 of this title; and
            ``(2)(A) 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--
                    ``(i) the wait-time goals of the Veterans Health 
                Administration for such care or services, as determined 
                by the Secretary; or
                    ``(ii) a period determined by a health care 
                provider of the Department to be clinically necessary 
                for the receipt of such care or services;
            ``(B) 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 provider;
            ``(C) the veteran faces an excessive burden in accessing 
        hospital care or medical services from a medical facility of 
        the Department due to--
                    ``(i) geographical challenges;
                    ``(ii) environmental factors;
                    ``(iii) a medical condition of the veteran that 
                affects the ability to travel; or
                    ``(iv) such other factors as determined by the 
                Secretary;
            ``(D) the hospital care or medical services sought by the 
        veteran are not provided at a medical facility of the 
        Department that is accessible to the veteran;
            ``(E) the veteran is enrolled in the pilot program under 
        section 403 of the Veterans' Mental Health and Other Care 
        Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703 
        note) as of the date of the enactment of the Improving Veterans 
        Access to Care in the Community Act;
            ``(F) the veteran is assigned a primary care provider under 
        section 1705A of this title that is not a health care provider 
        of the Department; and
            ``(G) 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.
    ``(c) Eligible Providers.--(1) A health care provider is an 
eligible provider for purposes of this section if the health care 
provider is a health care provider specified in paragraph (2) and meets 
standards established by the Secretary for purposes of this section, 
including standards relating to education, certification, licensure, 
training, and employment history.
    ``(2) The health care providers specified in this paragraph are the 
following:
            ``(A) Any health care provider that is participating in the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.), including any physician furnishing 
        services under such program.
            ``(B) Any health care provider of a Federally-qualified 
        health center (as defined in section 1905(l)(2)(B) of the 
        Social Security Act (42 U.S.C. 1396d(l)(2)(B))).
            ``(C) Any health care provider of the Department of 
        Defense.
            ``(D) Any health care provider of the Indian Health 
        Service.
            ``(E) Any health care provider of an academic affiliate of 
        the Department of Veterans Affairs.
            ``(F) Any health care provider of a health system 
        established to serve Alaska Natives.
            ``(G) Any other health care provider that meets criteria 
        established by the Secretary for purposes of this section.
    ``(3) To promote the provision of high-quality and high-value 
health care under this section, the Secretary may develop a tiered 
provider network of eligible providers based on criteria established by 
the Secretary for purposes of this section.
    ``(d) Reimbursement Rates.--(1) The Secretary shall be primarily 
responsible for the payment of costs associated with hospital care and 
medical services furnished under this section.
    ``(2) To the extent practicable, the rates paid by the Secretary 
for hospital care and medical services furnished under this section--
            ``(A) shall not be more than the rates paid by the United 
        States to a provider of services (as defined in section 1861(u) 
        of the Social Security Act (42 U.S.C. 1395x(u))) or a supplier 
        (as defined in section 1861(d) of such Act (42 U.S.C. 
        1395x(d))) under the Medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395 et seq.) for the same care 
        or services; and
            ``(B) shall incorporate the use of value-based 
        reimbursement models to promote the provision of high-quality 
        care.
    ``(e) Prompt Payment Standard.--(1) An eligible provider that seeks 
reimbursement for hospital care or medical services furnished under 
this section shall submit to the Secretary a claim for reimbursement 
not later than 180 days after furnishing such care or services.
    ``(2) Notwithstanding any other provision of law, the Secretary 
shall reimburse an eligible provider for hospital care or medical 
services furnished under this section--
            ``(A) in the case of a clean claim submitted to the 
        Secretary on paper, not later than 45 calendar days after 
        receiving the claim; or
            ``(B) in the case of a clean claim submitted to the 
        Secretary electronically, not later than 30 calendar days after 
        receiving the claim.
    ``(3)(A) If the Secretary denies a claim submitted by an eligible 
provider under paragraph (1), the Secretary shall notify the eligible 
provider of the reason for denying the claim and the additional 
information, if any, that may be required to process the claim--
            ``(i) in the case of a clean claim submitted to the 
        Secretary on paper, not later than 45 calendar days after 
        receiving the claim; or
            ``(ii) in the case of a clean claim submitted to the 
        Secretary electronically, not later than 30 calendar days after 
        receiving the claim.
    ``(B) Upon receipt by the Secretary of additional information 
specified under subparagraph (A) relating to a claim, the Secretary 
shall pay, deny, or otherwise adjudicate the claim, as appropriate, not 
later than 30 calendar days after receiving such information.
    ``(4)(A) If the Secretary has not reimbursed an eligible provider 
or denied a claim for reimbursement by the eligible provider under this 
subsection during the appropriate period specified in this subsection, 
such claim shall be considered overdue.
    ``(B) If a valid claim for reimbursement by an eligible provider is 
considered overdue under subparagraph (A), in addition to the amount 
the Secretary owes the eligible provider under the claim, the Secretary 
shall owe the eligible provider an interest penalty amount that shall--
            ``(i) be prorated daily;
            ``(ii) accrue from the date the payment was overdue;
            ``(iii) be payable at the time the claim is paid; and
            ``(iv) be computed at the rate of interest established by 
        the Secretary of the Treasury, and published in the Federal 
        Register, for interest payments under subsections (a)(1) and 
        (b) of section 7109 of title 41 that is in effect at the time 
        the Secretary accrues the obligation to pay the interest 
        penalty amount.
    ``(5)(A) If the Secretary overpays an eligible provider for 
hospital care or medical services furnished under this section, the 
Secretary shall deduct the amount of any overpayment from payments due 
to the eligible provider after the date of such overpayment.
    ``(B)(i) Before deducting any amount from a payment to an eligible 
provider under subparagraph (A), the Secretary shall ensure that the 
eligible provider is provided an opportunity--
            ``(I) to dispute the existence or amount of any overpayment 
        owed to the Department; and
            ``(II) to request a compromise with respect to any such 
        overpayment.
    ``(ii) The Secretary may not make any deduction from a payment to 
an eligible provider under subparagraph (A) unless the Secretary has 
made reasonable efforts to notify the eligible provider of the rights 
of the eligible provider under subclauses (I) and (II) of clause (i).
    ``(iii) Upon receiving a dispute under subclause (I) of clause (i) 
or a request under subclause (II) of such clause, the Secretary shall 
make a determination with respect to such dispute or request before 
making any deduction under subparagraph (A) unless the time required to 
make such a determination would jeopardize the ability of the Secretary 
to recover the full amount owed to the Department.
    ``(6) Notwithstanding any other provision of law--
            ``(A) the authority of the Secretary to make deductions 
        under paragraph (5) or take any other action for the purpose of 
        collecting a debt owed to the United States under this section 
        shall not be subject to any limitation with respect to the time 
        for bringing civil actions or for commencing administrative 
        proceedings; and
            ``(B) the Secretary may, except in the case of a fraudulent 
        claim, false claim, or misrepresented claim, compromise any 
        claim of an amount owed to the United States under this 
        section.
    ``(7) This subsection shall apply only to payments made on a claims 
basis and not to capitation or other forms of periodic payments to 
eligible providers.
    ``(f) Cost Sharing.--(1) The Secretary shall require an eligible 
veteran to pay a copayment for the receipt of hospital care or medical 
services under this section only if such eligible veteran would be 
required to pay a copayment for the receipt of such care or services 
under this chapter at a medical facility of the Department or from a 
health care provider of the Department.
    ``(2) The amount of any copayment charged to an eligible veteran 
under paragraph (1) for the receipt of hospital care or medical 
services under this section may not exceed the amount of the copayment 
that would be payable by such eligible veteran for the receipt of such 
care or services under this chapter at a medical facility of the 
Department or from a health care provider of the Department.
    ``(g) Coordination of Care and Services.--The Secretary shall 
establish such procedures to promote coordination of care and the 
sharing of health information as the Secretary considers appropriate to 
carry out this section.
    ``(h) Regulations.--The Secretary shall prescribe regulations to 
carry out this section.
    ``(i) Effective Date.--The Secretary may not furnish hospital care 
or medical services under this section before the date specified in 
section 101(p)(2) of the Veterans Access, Choice, and Accountability 
Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note).
    ``(j) Definitions.--In this section:
            ``(1) The term `Alaska Native' means a person who is a 
        member of any Native village, Village Corporation, or Regional 
        Corporation, as those terms are defined in section 3 of the 
        Alaska Native Claims Settlement Act (43 U.S.C. 1602).
            ``(2) The term `clean claim' means a claim submitted--
                    ``(A) to the Secretary by an eligible provider for 
                purposes of payment by the Secretary of expenses for 
                hospital care or medical services furnished under this 
                section;
                    ``(B) that contains substantially all of the 
                required elements necessary for accurate adjudication, 
                without requiring additional information from the 
                eligible provider; and
                    ``(C) in such format as may be prescribed by the 
                Secretary for purposes of paying claims for hospital 
                care or medical services furnished under this section.
            ``(3) The term `fraudulent claim'--
                    ``(A) means a claim by a health care provider for 
                reimbursement under this section that includes an 
                intentional and deliberate misrepresentation of a 
                material fact or facts that is intended to induce the 
                Secretary to pay an amount that was not legally owed to 
                the provider; and
                    ``(B) does not include a claim in which a 
                misrepresentation is made in reliance on a good faith 
                interpretation by a health care provider of the 
                utilization, medical necessity, coding, or billing 
                requirements of the Secretary.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1703 the following new item:

``1703A. Veterans Choice Program.''.

SEC. 102. EXPANSION OF REIMBURSEMENT OF VETERANS FOR EMERGENCY 
              TREATMENT AND URGENT CARE.

    (a) In General.--Section 1725 of title 38, United States Code, is 
amended to read as follows:
``Sec. 1725. Reimbursement for emergency treatment and urgent care
    ``(a) In General.--(1) Subject to the provisions of this section, 
the Secretary shall reimburse a veteran described in subsection (b) for 
the reasonable value of emergency treatment or urgent care furnished 
the veteran in a non-Department facility.
    ``(2) In any case in which reimbursement of a veteran is authorized 
under paragraph (1), the Secretary may, in lieu of reimbursing the 
veteran, make payment of the reasonable value of the furnished 
emergency treatment or urgent care directly--
            ``(A) to the hospital or other health care provider that 
        furnished the treatment or care; or
            ``(B) to the person or organization that paid for such 
        treatment or care on behalf of the veteran.
    ``(b) Eligibility.--A veteran described in this subsection is an 
individual who--
            ``(1) is enrolled in the patient enrollment system of the 
        Department established and operated under section 1705 of this 
        title; and
            ``(2) has received care under this chapter during the 24-
        month period preceding the furnishing of the emergency 
        treatment or urgent care for which reimbursement is sought 
        under this section.
    ``(c) Emergency Transportation.--Notwithstanding section 111 of 
this title, reimbursement of emergency treatment or urgent care under 
this section shall include reimbursement for the reasonable value of 
emergency transportation.
    ``(d) Responsibility for Payment.--The Secretary shall be primarily 
responsible for reimbursing or otherwise paying the reasonable value of 
emergency treatment or urgent care under this section.
    ``(e) Limitations on Payment.--(1) The Secretary, in accordance 
with regulations prescribed by the Secretary for purposes of this 
section, shall--
            ``(A) establish the maximum amount payable under subsection 
        (a); and
            ``(B) delineate the circumstances under which such payments 
        may be made, including such requirements on requesting 
        reimbursement as the Secretary may establish.
    ``(2)(A) Payment by the Secretary under this section on behalf of a 
veteran to a provider of emergency treatment or urgent care shall, 
unless rejected and refunded by the provider within 30 days of 
receipt--
            ``(i) constitute payment in full for the emergency 
        treatment or urgent care provided; and
            ``(ii) extinguish any liability on the part of the veteran 
        for that treatment or care.
    ``(B) Neither the absence of a contract or agreement between the 
Secretary and a provider of emergency treatment or urgent care nor any 
provision of a contract, agreement, or assignment to the contrary shall 
operate to modify, limit, or negate the requirements of subparagraph 
(A).
    ``(C) A provider of emergency treatment or urgent care may not seek 
to recover from any third party the cost of emergency treatment or 
urgent care for which the provider has received payment from the 
Secretary under this section.
    ``(f) Recovery.--The United States has the right to recover or 
collect reasonable charges for emergency treatment or urgent care 
furnished under this section in accordance with the provisions of 
section 1729 of this title.
    ``(g) Copayments.--(1) Except as provided in paragraph (2), a 
veteran shall pay to the Department a copayment (in an amount 
prescribed by the Secretary for purposes of this section) for each 
episode of emergency treatment or urgent care for which reimbursement 
is provided to the veteran under this section.
    ``(2) The requirement under paragraph (1) to pay a copayment does 
not apply to a veteran who--
            ``(A) would not be required to pay to the Department a 
        copayment for emergency treatment or urgent care furnished at 
        facilities of the Department;
            ``(B) meets an exemption specified by the Secretary in 
        regulations prescribed by the Secretary for purposes of this 
        section; or
            ``(C) is admitted to a hospital for treatment or 
        observation following, and in connection with, the emergency 
        treatment or urgent care for which the veteran is provided 
        reimbursement under this section.
    ``(3) The requirement that a veteran pay a copayment under this 
section shall apply notwithstanding the authority of the Secretary to 
offset such a requirement with amounts recovered from a third party 
under section 1729 of this title.
    ``(h) Definitions.--In this section:
            ``(1) The term `emergency treatment' means medical care or 
        services furnished, in the judgment of the Secretary--
                    ``(A) when such care or services are rendered in a 
                medical emergency of such nature that a prudent 
                layperson reasonably expects that delay in seeking 
                immediate medical attention would be hazardous to life 
                or health; and
                    ``(B) until--
                            ``(i) such time as the veteran can be 
                        transferred safely to a Department facility or 
                        community care provider authorized by the 
                        Secretary and such facility or provider is 
                        capable of accepting such transfer; or
                            ``(ii) such time as a Department facility 
                        or community care provider authorized by the 
                        Secretary accepts such transfer if--
                                    ``(I) at the time the veteran could 
                                have been transferred safely to such a 
                                facility or provider, no such facility 
                                or provider agreed to accept such 
                                transfer; and
                                    ``(II) the non-Department facility 
                                in which such medical care or services 
                                was furnished made and documented 
                                reasonable attempts to transfer the 
                                veteran to a Department facility or 
                                community care provider.
            ``(2) The term `health-plan contract' includes any of the 
        following:
                    ``(A) An insurance policy or contract, medical or 
                hospital service agreement, membership or subscription 
                contract, or similar arrangement under which health 
                services for individuals are provided or the expenses 
                of such services are paid.
                    ``(B) An insurance program described in section 
                1811 of the Social Security Act (42 U.S.C. 1395c) or 
                established by section 1831 of such Act (42 U.S.C. 
                1395j).
                    ``(C) A State plan for medical assistance approved 
                under title XIX of such Act (42 U.S.C. 1396 et seq.).
                    ``(D) A workers' compensation law or plan described 
                in section 1729(a)(2)(A) of this title.
            ``(3) The term `third party' means any of the following:
                    ``(A) A Federal entity.
                    ``(B) A State or political subdivision of a State.
                    ``(C) An employer or an employer's insurance 
                carrier.
                    ``(D) An automobile accident reparations insurance 
                carrier.
                    ``(E) A person or entity obligated to provide, or 
                to pay the expenses of, health services under a health-
                plan contract.
            ``(4) The term `urgent care' shall have the meaning given 
        that term by the Secretary in regulations prescribed by the 
        Secretary for purposes of this section.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 is amended by striking the item relating to section 1725 and 
inserting the following new item:

``1725. Reimbursement for emergency treatment and urgent care.''.
    (c) Repeal of Superseded Authority.--Section 1728 is repealed.
    (d) Conforming Amendments.--
            (1) Medical care for survivors and dependents.--Section 
        1781(a)(4) is amended by striking ``(as defined in section 
        1725(f) of this title)'' and inserting ``(as defined in section 
        1725(h) of this title)''.
            (2) Health care of family members of veterans stationed at 
        camp lejeune, north carolina.--Section 1787(b)(3) is amended by 
        striking ``(as defined in section 1725(f) of this title)'' and 
        inserting ``(as defined in section 1725(h) of this title)''.
    (e) Regulations.--Not later than 270 days after the date of the 
enactment of this Act, the Secretary shall prescribe regulations to 
carry out the amendments made by this section.
    (f) Effective Date.--The amendments made by this section shall take 
effect one year after the date of the enactment of this Act.

SEC. 103. TERMINATION OF CERTAIN PROVISIONS AUTHORIZING CARE TO 
              VETERANS THROUGH NON-DEPARTMENT OF VETERANS AFFAIRS 
              PROVIDERS.

    (a) Termination of Authority To Contract for Care in Non-Department 
Facilities.--
            (1) In general.--Section 1703 of title 38, United States 
        Code, is amended by adding at the end the follow new 
        subsection:
    ``(e) The authority of the Secretary under this section terminates 
on December 31, 2017.''.
            (2) Conforming amendments.--
                    (A) In general.--
                            (i) Dental care.--Section 1712(a) of such 
                        title is amended--
                                    (I) in paragraph (3), by striking 
                                ``under clause (1), (2), or (5) of 
                                section 1703(a) of this title'' and 
                                inserting ``or entered into an 
                                agreement under this title''; and
                                    (II) in paragraph (4)(A), in the 
                                first sentence--
                                            (aa) by striking ``and 
                                        section 1703 of this title''; 
                                        and
                                            (bb) by striking ``in 
                                        section 1703 of this title'' 
                                        and inserting ``in this 
                                        title''.
                            (ii) Readjustment counseling.--Section 
                        1712A(e)(1) of such title is amended--
                                    (I) by inserting ``or agreements'' 
                                after ``contracts''; and
                                    (II) by striking ``(under sections 
                                1703(a)(2) and 1710(a)(1)(B) of this 
                                title)''.
                            (iii) Death in department facility.--
                        Section 2303(a)(2)(B)(i) of such title is 
                        amended by striking ``section 1703'' and 
                        inserting ``a contract or agreement entered 
                        into under this title''.
                            (iv) Medicare provider agreements.--Section 
                        1866(a) of the Social Security Act (42 U.S.C. 
                        1395cc(a)) is amended by striking ``under 
                        section 1703 of title 38'' and inserting 
                        ``under title 38, United States Code,''.
                    (B) Effective date.--The amendments made by 
                subparagraph (A) shall take effect on December 17, 
                2017.
    (b) Repeal of Authority To Contract for Scarce Medical 
Specialists.--
            (1) In general.--Section 7409 of such title is repealed.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 74 is amended by striking the item 
        relating to section 7409.

           TITLE II--AUTHORITY TO PAY FOR NON-DEPARTMENT CARE

SEC. 201. AUTHORIZATION OF AGREEMENTS BETWEEN THE DEPARTMENT OF 
              VETERANS AFFAIRS AND NON-DEPARTMENT HEALTH CARE 
              PROVIDERS.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, as amended by section 101(a), is further amended by 
inserting after section 1703A the following new section:
``Sec. 1703B. Veterans Care Agreements
    ``(a) Agreements To Furnish Care.--(1) If the Secretary is not 
feasibly able to furnish hospital care, medical services, or extended 
care under this chapter at facilities of the Department or under 
contracts or sharing agreements entered into under authorities other 
than this section, the Secretary may furnish such care and services by 
entering into agreements under this section with eligible providers 
that are certified under subsection (c). An agreement entered into 
under this section may be referred to as a `Veterans Care Agreement'.
    ``(2) The Secretary is not feasibly able to furnish care or 
services as described in paragraph (1) 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, contracts, or sharing 
agreements impracticable or inadvisable.
    ``(3) Eligibility of a veteran under this section for the 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.
    ``(b) Eligible Providers.--For purposes of this section, an 
eligible provider is one of the following:
            ``(1) 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)).
            ``(2) 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)).
            ``(3) 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.
            ``(4) A provider that is--
                    ``(A) 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
                    ``(B) a center for independent living (as defined 
                in section 702 of the Rehabilitation Act of 1973 (29 
                U.S.C. 796a)).
            ``(5) Such other health care providers as the Secretary 
        considers appropriate for purposes of this section.
    ``(c) Certification of Eligible Providers.--(1) The Secretary shall 
establish a process for the certification of eligible providers under 
this section that shall, at a minimum, set forth the following:
            ``(A) Procedures for the submittal of applications for 
        certification and deadlines for actions taken by the Secretary 
        with respect to such applications.
            ``(B) Standards and procedures for approval and denial of 
        certification, duration of certification, revocation of 
        certification, and recertification.
            ``(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. 1395cc(j)(2)(B)) and the 
        standards set forth under section 9.104 of title 48, Code of 
        Federal Regulations, or any successor regulation.
    ``(2) The Secretary shall deny or revoke certification to an 
eligible provider under this subsection if the Secretary determines 
that the eligible provider is currently--
            ``(A) 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
            ``(B) identified as an excluded source on the list 
        maintained in the System for Award Management, or any successor 
        system.
    ``(d) Terms of Agreements.--Each agreement entered into with an 
eligible provider under this section shall 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, the rates paid by the United States for such care 
        and services 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.).
            ``(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 and services.
            ``(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 or 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 or services under this section to the Department in a 
        timeframe and format specified by the Secretary for purposes of 
        this section.
            ``(7) To meet such other terms and conditions, including 
        quality of care assurance standards, as the Secretary may 
        specify for purposes of this section.
    ``(e) Termination of Agreements.--(1) 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.
    ``(2) 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--
            ``(A) 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;
            ``(B) determines that the 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;
            ``(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 or the Department; or
            ``(D) determines that it is reasonable to terminate the 
        agreement based on the health care needs of a veteran or 
        veterans.
    ``(f) Periodic Review of Certain Agreements.--(1) 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.
    ``(2)(A) Subject to subparagraph (B), a Veterans Care Agreement is 
of material size as determined by the Secretary for purposes of this 
section.
    ``(B) 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.
    ``(g) Exclusion of Certain Federal Contracting Provisions.--(1) 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.
    ``(2)(A) Except as provided in subparagraph (B) and unless 
otherwise provided in this section or in 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 to which providers of services and suppliers 
under the Medicare program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) are not subject.
    ``(B) An eligible provider that enters into an agreement under this 
section is subject to--
            ``(i) all laws regarding integrity, ethics, fraud, or that 
        subject a person to civil or criminal penalties; and
            ``(ii) all laws that protect against employment 
        discrimination or that otherwise ensure equal employment 
        opportunities.
    ``(h) Monitoring of Quality of Care.--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--
            ``(1) to monitor the quality of care and services furnished 
        to veterans under this section; and
            ``(2) to assess the quality of care and services furnished 
        by an eligible provider for purposes of determining whether to 
        renew an agreement under this section with the eligible 
        provider.
    ``(i) Dispute Resolution.--(1) The Secretary shall establish 
administrative procedures for eligible providers with which the 
Secretary has entered an agreement under this section 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 an agreement 
under this section, an eligible provider must first exhaust the 
administrative procedures established by the Secretary under paragraph 
(1).''.
    (b) Regulations.--The Secretary of Veterans Affairs shall prescribe 
an interim final rule to carry out section 1703B of such title, as 
added by subsection (a), not later than one year after the date of the 
enactment of this Act.
    (c) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title, as amended by section 101(b), is further 
amended by inserting after the item related to section 1703A the 
following new item:

``1703B. Veterans Care Agreements.''.

SEC. 202. MODIFICATION OF AUTHORITY TO ENTER INTO AGREEMENTS WITH STATE 
              HOMES TO PROVIDE NURSING HOME CARE.

    (a) Use of Agreements.--
            (1) In general.--Paragraph (1) of section 1745(a) of title 
        38, United States Code, is amended, in the matter preceding 
        subparagraph (A), by striking ``a contract (or agreement under 
        section 1720(c)(1) of this title)'' and inserting ``an 
        agreement''.
            (2) Payment.--Paragraph (2) of such section is amended by 
        striking ``contract (or agreement)'' each place it appears and 
        inserting ``agreement''.
    (b) Exclusion of Certain Federal Contracting Provisions.--Such 
section is amended by adding at the end the following new paragraph:
    ``(4)(A) 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.
    ``(B)(i) Except as provided in clause (ii) and unless otherwise 
provided in this section or in regulations prescribed pursuant to this 
section, a State home that enters into an agreement under this section 
is not subject to, in the carrying out of the agreement, any law to 
which providers of services and suppliers under the Medicare program 
under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
are not subject.
    ``(ii) A State home that enters into an agreement under this 
section is subject to--
            ``(I) all laws regarding integrity, ethics, fraud, or that 
        subject a person to civil or criminal penalties; and
            ``(II) all laws that protect against employment 
        discrimination or that otherwise ensure equal employment 
        opportunities.''.
    (c) Effective Date.--
            (1) In general.--The amendments made by this section shall 
        apply to agreements entered into under section 1745 of such 
        title on and after the date on which the regulations prescribed 
        by the Secretary of Veterans Affairs to implement such 
        amendments take effect.
            (2) Publication.--The Secretary shall publish the date 
        described in paragraph (1) in the Federal Register not later 
        than 30 days before such date.

SEC. 203. REQUIREMENT FOR ADVANCE APPROPRIATIONS FOR THE CARE IN THE 
              COMMUNITY ACCOUNT OF THE DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Section 117(c) of title 38, United States Code, is 
amended by adding at the end the following new paragraph:
            ``(7) Veterans Health Administration, Care in the 
        Community.''.
    (b) Conforming Amendment.--Section 1105(a)(37) of title 31, United 
States Code, is amended by adding at the end the following new 
subparagraph:
                    ``(G) Veterans Health Administration, Care in the 
                Community.''.
    (c) Applicability.--The amendments made by this section shall apply 
to fiscal years beginning on and after October 1, 2016.

SEC. 204. ANNUAL TRANSFER OF AMOUNTS WITHIN DEPARTMENT OF VETERANS 
              AFFAIRS TO PAY FOR HEALTH CARE FROM NON-DEPARTMENT 
              PROVIDERS.

    Section 106 of the Veterans Access, Choice, and Accountability Act 
of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended by adding 
at the end the following new subsection:
    ``(c) Annual Transfer of Amounts.--
            ``(1) In general.--At the beginning of each fiscal year, 
        the Secretary of Veterans Affairs shall transfer to the Chief 
        Business Office of the Veterans Health Administration an amount 
        equal to the amount estimated to be required to furnish 
        hospital care, medical services, and other health care through 
        non-Department of Veterans Affairs providers during that fiscal 
        year.
            ``(2) Adjustments.--During a fiscal year, the Secretary may 
        make adjustments to the amount transferred under paragraph (1) 
        for that fiscal year to accommodate any variances in demand for 
        hospital care, medical services, or other health care through 
        non-Department providers.''.

SEC. 205. ELIMINATION OF REQUIREMENT TO ACT AS SECONDARY PAYER FOR CARE 
              RELATING TO NON-SERVICE-CONNECTED DISABILITIES UNDER 
              CHOICE PROGRAM.

    (a) In General.--Section 101(e) of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is 
amended--
            (1) by striking paragraphs (2) and (3);
            (2) by redesignating paragraph (4) as paragraph (3); and
            (3) by inserting after paragraph (1) the following new 
        paragraph (2):
            ``(2) Responsibility for costs of certain care.--In any 
        case in which an eligible veteran is furnished hospital care or 
        medical services under this section for a non-service-connected 
        disability described in subsection (a)(2) of section 1729 of 
        title 38, United States Code, the Secretary may recover or 
        collect reasonable charges for such care or services from a 
        health-care plan described in paragraph (3) in accordance with 
        such section.''.
    (b) Conforming Amendment.--Paragraph (1) of such section is amended 
by striking ``paragraph (4)'' and inserting ``paragraph (3)''.

SEC. 206. AUTHORIZATION OF USE OF CERTAIN AMOUNTS APPROPRIATED TO THE 
              VETERANS CHOICE FUND FOR OTHER NON-DEPARTMENT OF VETERANS 
              AFFAIRS CARE.

    (a) In General.--Section 802 of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is 
amended--
            (1) in subsection (c)--
                    (A) in paragraph (1)--
                            (i) by striking ``Except as provided by 
                        paragraph (3), any'' and inserting ``Any''; and
                            (ii) by striking ``by the Secretary of 
                        Veterans Affairs'' and all that follows through 
                        the period at the end and inserting ``by the 
                        Secretary of Veterans Affairs--
                    ``(A) to carry out section 101, including, subject 
                to paragraph (2), any administrative requirements of 
                such section;
                    ``(B) to furnish health care to individuals under 
                chapter 17 of title 38, United States Code, at non-
                Department facilities, including pursuant to authority 
                other than the authority under section 101; and
                    ``(C) to furnish disability examinations conducted 
                by health care providers that are not health care 
                providers of the Department of Veterans Affairs.''; and
                    (B) by striking paragraph (3) and inserting the 
                following new paragraphs:
            ``(3) Treatment of amounts.--Amounts made available to the 
        Secretary under this subsection shall be used to supplement, 
        not supplant, amounts made available to the Secretary in the 
        Medical Services account of the Department of Veterans Affairs.
            ``(4) Non-department facilities defined.--In this 
        subsection, the term `non-Department facilities' has the 
        meaning given that term in section 1701 of title 38, United 
        States Code.''; and
            (2) in subsection (d)(1), by striking ``only for the 
        program'' and all that follows through the period at the end 
        and inserting ``only for the purposes specified in subsection 
        (c)(1).''.
    (b) Emergency Designations.--
            (1) In general.--This section is designated as an emergency 
        requirement pursuant to section 4(g) of the Statutory Pay-As-
        You-Go Act of 2010 (2 U.S.C. 933(g)).
            (2) Designation in senate.--In the Senate, this section is 
        designated as an emergency requirement pursuant to section 
        403(a) of S. Con. Res. 13 (111th Congress), the concurrent 
        resolution on the budget for fiscal year 2010.

SEC. 207. MODIFICATION OF PROCESS THROUGH WHICH DEPARTMENT OF VETERANS 
              AFFAIRS RECORDS OBLIGATIONS FOR NON-DEPARTMENT CARE.

    (a) In General.--Subchapter III of chapter 17 of title 38, United 
States Code, is amended by adding at the end the following new section:
``Sec. 1730B. Recording obligations for care at non-Department 
              facilities
    ``The Secretary may record as an obligation of the United States 
Government amounts owed for hospital care or medical services furnished 
under this chapter at non-Department facilities on the date on which a 
claim by a health care provider for payment is approved rather than on 
the date that the hospital care or medical services are authorized by 
the Secretary.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1730A the following new item:

``1730B. Recording obligations for care at non-Department 
                            facilities.''.

                  TITLE III--OTHER HEALTH CARE MATTERS

SEC. 301. TREATMENT OF DEPARTMENT OF VETERANS AFFAIRS AS PARTICIPATING 
              PROVIDER FOR RECOVERY OF COSTS OF CERTAIN MEDICAL CARE.

    Section 1729(f) of title 38, United States Code, is amended by 
striking ``(f) No law'' and inserting the following:
    ``(f)(1) In the case of a veteran who is entitled to care (or 
payment of the expenses of care) under a health-plan contract, for 
purposes of reimbursement for providing care or services under this 
chapter to that veteran for a non-service-connected disability 
described in subparagraph (D) or (E) of subsection (a)(2), the 
Department shall be treated as a participating provider under that 
health-plan contract.
    ``(2) No law''.

SEC. 302. PRIMARY CARE PROVIDERS FOR VETERANS ENROLLED IN PATIENT 
              ENROLLMENT SYSTEM OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is amended by inserting after section 1705 the following 
new section:
``Sec. 1705A. Management of health care: primary care provider
    ``(a) In General.--The Secretary shall, to the maximum extent 
possible, assign each veteran enrolled in the system of annual patient 
enrollment established and operated under section 1705 of this title a 
full-time primary care provider that meets the following criteria:
            ``(1) Except as provided in paragraph (2), located not more 
        than 40 miles driving distance from the residence of the 
        veteran.
            ``(2) If the veteran resides in a State without a medical 
        facility of the Department that provides hospital care, 
        emergency medical services, and surgical care, located not more 
        than 20 miles driving distance from the residence of the 
        veteran.
            ``(3) Located such that the veteran is not required to 
        travel by air, boat, or ferry or overcome an unusual or 
        excessive burden to access the primary care provider.
    ``(b) Types of Providers.--In carrying out this section, the 
Secretary may select from among primary care providers that are health 
care providers of the Department and primary care providers that are 
not health care providers of the Department.''.
    (b) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item 
relating to section 1705 the following new item:

``1705A. Management of health care: primary care provider.''.
                                 <all>