[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4783 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 4783

To amend the Veterans Access, Choice, and Accountability Act of 2014 to 
  improve the scheduling of appointments, the accountability of third 
party administrators, and payment to providers under such Act, and for 
                            other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 11, 2018

 Ms. Rosen (for herself and Mr. Jones) introduced the following bill; 
        which was referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To amend the Veterans Access, Choice, and Accountability Act of 2014 to 
  improve the scheduling of appointments, the accountability of third 
party administrators, and payment to providers under such Act, 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.

    This Act may be cited as the ``Veterans Deserve Better Act''.

SEC. 2. PAYMENT TO PROVIDERS UNDER VETERANS CHOICE PROGRAM, SCHEDULING 
              OF APPOINTMENTS, AND ACCOUNTABILITY OF THIRD PARTY 
              ADMINISTRATORS UNDER SUCH PROGRAM.

    Section 101 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 subsections:
    ``(u) Prompt Payment.--
            ``(1) Payment of claims.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this section or any other provision of 
                law, the Secretary shall pay for hospital care or 
                medical services furnished by a health care entity or 
                provider under this section within 45 calendar days 
                upon receipt of a clean paper claim or 30 calendar days 
                upon receipt of a clean electronic claim.
                    ``(B) Denial.--If a claim is denied, the Secretary 
                shall, within 45 calendar days of denial for a paper 
                claim and 30 calendar days of denial for an electronic 
                claim, notify the health care entity or provider of the 
                reason for denying the claim and what, if any, 
                additional information is required to process the 
                claim.
                    ``(C) Additional information.--Upon the receipt of 
                additional information described in subparagraph (B) 
                with respect to a denied claim, the Secretary shall 
                ensure that the claim is paid, denied, or otherwise 
                adjudicated within 30 calendar days from the receipt of 
                the requested information.
                    ``(D) Invoice basis.--This subsection shall only 
                apply to payments made on an invoice basis and shall 
                not apply to capitation or other forms of periodic 
                payment.
            ``(2) Submittal of claims.--A health care entity or 
        provider that furnishes hospital care or medical services under 
        this section shall submit to the Secretary a claim for payment 
        for furnishing the hospital care or medical services not later 
        than 180 days after the date on which the health care entity or 
        provider furnished the hospital care or medical services.
            ``(3) Fraudulent claims.--
                    ``(A) In general.--Sections 3729 through 3733 of 
                title 31, United States Code, shall apply to fraudulent 
                claims for payment submitted to the Secretary by a 
                health care entity or provider under this section.
                    ``(B) Preclusion of certain providers.--Pursuant to 
                regulations prescribed by the Secretary, the Secretary 
                shall bar a health care entity or provider from 
                furnishing hospital care or medical services under this 
                section if the Secretary determines the health care 
                entity or provider has submitted to the Secretary 
                fraudulent health care claims for payment by the 
                Secretary.
            ``(4) Overdue claims.--
                    ``(A) In general.--Any claim that has not been 
                denied with notice, made pending with notice, or paid 
                to a health care entity or provider by the Secretary 
                shall be overdue if the notice or payment is not 
                received by the health care entity or provider within 
                the time periods specified in paragraph (1).
                    ``(B) Interest.--
                            ``(i) In general.--If a claim is overdue 
                        under this paragraph, the Secretary may, under 
                        the requirements established by paragraph (1) 
                        and consistent with the provisions of chapter 
                        39 of title 31, United States Code (commonly 
                        referred to as the `Prompt Payment Act'), 
                        require that interest be paid on clean claims.
                            ``(ii) Computation.--Interest paid under 
                        clause (i) shall be computed at the rate of 
                        interest established by the Secretary of the 
                        Treasury under section 3902 of title 31, United 
                        States Code, and published in the Federal 
                        Register.
                    ``(C) Report.--Not less frequently than annually, 
                the Secretary shall submit to Congress a report on 
                payment of overdue claims under this paragraph, 
                disaggregated by paper and electronic claims, that 
                includes the following:
                            ``(i) The amount paid in overdue claims 
                        under this paragraph, disaggregated by the 
                        amount of the overdue claim and the amount of 
                        interest paid on such overdue claim.
                            ``(ii) The number of such overdue claims 
                        and the average number of days late each claim 
                        was paid, disaggregated by facility of the 
                        Department and Veterans Integrated Service 
                        Network region.
            ``(5) Overpayment.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the Secretary shall deduct the amount 
                of any overpayment from payments due a health care 
                entity or provider under this section.
                    ``(B) Notification of right to dispute.--
                            ``(i) In general.--Deductions may not be 
                        made under this paragraph unless the Secretary 
                        has made reasonable efforts to notify a health 
                        care entity or provider of the right to dispute 
                        the existence or amount of such indebtedness 
                        and the right to request a compromise of such 
                        indebtedness.
                            ``(ii) Determination.--The Secretary shall 
                        make a determination with respect to any 
                        dispute or request under clause (i) prior to 
                        deducting any overpayment under this paragraph 
                        unless the time required to make such a 
                        determination before making any deductions 
                        would jeopardize the Secretary's ability to 
                        recover the full amount of such indebtedness.
            ``(6) Information and documentation required.--
                    ``(A) In general.--The Secretary shall provide to 
                all health care entities or providers furnishing 
                hospital care or medical services under this section a 
                list of information and documentation that is required 
                to establish a clean claim under this subsection.
                    ``(B) Consultation with health care entities.--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 subparagraph (A).
                    ``(C) Notification of modifications.--If the 
                Secretary modifies the information and documentation 
                included in the list under subparagraph (A), the 
                Secretary shall notify all health care entities or 
                providers described in such subparagraph not later than 
                30 days before such modifications take effect.
            ``(7) Processing of claims.--In processing a claim for 
        compensation for hospital care or medical services furnished by 
        a health care entity or provider under this section, the 
        Secretary shall act through--
                    ``(A) a non-Department entity that has entered into 
                an agreement with the Secretary under this section; or
                    ``(B) a non-Department entity that specializes in 
                processing such claims for other Federal agency health 
                care systems.
            ``(8) Treatment of certain outstanding claims.--
                    ``(A) Report.--Not later than 30 days after the 
                date of the enactment of the Veterans Deserve Better 
                Act, the Secretary shall submit to the appropriate 
                committees of Congress a report on the number of claims 
                for payment for hospital care and medical services 
                furnished to eligible veterans under this section that 
                are outstanding as of the date of the submittal of the 
                report.
                    ``(B) Outreach to providers.--Notwithstanding any 
                other provision of this section, with respect to each 
                health care entity or provider that has an outstanding 
                claim for payment for hospital care and medical 
                services furnished to eligible veterans under this 
                section as of the date of the enactment of the Veterans 
                Deserve Better Act, not later than 45 days after such 
                date of enactment, the Secretary shall either pay the 
                claim, deny the claim, or request additional 
                information regarding the claim.
            ``(9) Definitions.--In this subsection:
                    ``(A) The term `appropriate committees of Congress' 
                means--
                            ``(i) the Committee on Veterans' Affairs 
                        and the Committee on Appropriations of the 
                        Senate; and
                            ``(ii) the Committee on Veterans' Affairs 
                        and the Committee on Appropriations of the 
                        House of Representatives.
                    ``(B) The term `clean electronic claim' means the 
                transmission of data for purposes of payment of covered 
                health care expenses that is submitted to the Secretary 
                which contains substantially all of the required data 
                elements necessary for accurate adjudication, without 
                obtaining additional information from the health care 
                entity or provider that furnished the care or service, 
                submitted in such format as prescribed by the Secretary 
                in regulations for the purpose of paying claims for 
                care or services.
                    ``(C) The term `clean paper claim' means a paper 
                claim for payment of covered health care expenses that 
                is submitted to the Secretary which contains 
                substantially all of the required data elements 
                necessary for accurate adjudication, without obtaining 
                additional information from the health care entity or 
                provider that furnished the care or service, submitted 
                in such format as prescribed by the Secretary in 
                regulations for the purpose of paying claims for care 
                or services.
                    ``(D) The term `fraudulent claims'--
                            ``(i) means the intentional and deliberate 
                        misrepresentation of a material fact or facts 
                        by a health care entity or provider made to 
                        induce the Secretary to pay a claim that was 
                        not legally payable to that entity or provider; 
                        and
                            ``(ii) does not include a good faith 
                        interpretation by a health care entity or 
                        provider of utilization, medical necessity, 
                        coding, and billing requirements of the 
                        Secretary.
                    ``(E) The term `health care entity or provider' 
                means any health care entity or provider that is an 
                entity described in subsection (a)(1)(B), excluding any 
                Federal health care entity or provider.
    ``(v) Information on Scheduling Appointments.--The Secretary shall 
provide to each eligible veteran who seeks an appointment for care or 
services under this section the following:
            ``(1) Information on the time required for a veteran to 
        make an appointment for such care or services under this 
        section in the region in which the veteran resides.
            ``(2) With respect to appointments made through third party 
        administrators--
                    ``(A) information on what will happen if the third 
                party administrator cannot schedule an appointment for 
                the provision of such care or services;
                    ``(B) a list of other health care providers in the 
                region in which the veteran resides that are within the 
                network of the third party administrator; and
                    ``(C) information on how the veteran can file with 
                the Secretary a complaint concerning the handling of an 
                appointment by the third party administrator.
    ``(w) Requirements of Third Party Administrators.--
            ``(1) Appointment timing.--The Secretary shall ensure that 
        each contract with a third party administrator requires the 
        third party administrator to schedule an appointment for care 
        or services under this section for an eligible veteran not 
        later than five days after the eligible veteran elects to 
        receive such care or services under this section.
            ``(2) Tracking of appointments.--The Secretary shall track 
        all appointments for care and services under this section that 
        are scheduled directly through a third party administrator.
            ``(3) Follow-up.--The Secretary shall follow up with a 
        third party administrator regarding any appointment for care or 
        services under this section that is pending to be scheduled by 
        the third party administrator for more than 5 days to determine 
        the reason for the delay in scheduling the appointment.
            ``(4) Report on overdue appointments.--The Secretary shall 
        require each third party administrator to submit to the 
        Secretary, not later than 30 days after the date of the 
        enactment of the Veterans Deserve Better Act, a list of the 
        appointments that, as of the submittal of the report, have been 
        pending scheduling by the third party administrator for a 
        period of more than 15 days.''.
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