[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5047 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5047

      To direct the Secretary of Veterans Affairs to carry out a 
 demonstration program to provide expanded access to medical services 
  through partnerships between Department of Veterans Affairs medical 
centers and Federally Qualified Health Centers, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           February 15, 2018

Mr. Bilirakis (for himself, Ms. Kuster of New Hampshire, Mr. Arrington, 
 Mr. Coffman, and Mr. Peters) introduced the following bill; which was 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
      To direct the Secretary of Veterans Affairs to carry out a 
 demonstration program to provide expanded access to medical services 
  through partnerships between Department of Veterans Affairs medical 
centers and Federally Qualified Health Centers, 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 ``VA Community Care Enhancement Act''.

SEC. 2. DEPARTMENT OF VETERANS AFFAIRS DEMONSTRATION PROGRAM ON 
              EXPANDED AVAILABILITY OF MEDICAL SERVICES THROUGH 
              CONTRACTS WITH FEDERALLY QUALIFIED HEALTH CENTERS.

    (a) Demonstration Program.--The Secretary of Veterans Affairs shall 
carry out a demonstration program under which the Secretary shall 
furnish certain medical services under chapter 17 of title 38, United 
States Code, through contracts between Department of Veterans Affairs 
medical centers and Federally Qualified Health Centers (hereinafter 
referred to as ``FQHCs'').
    (b) Community-Care Collaborative Arrangements.--Under the 
demonstration program, the Secretary shall enter into contracts, on 
behalf of Department medical centers, with not less than five separate 
FQHCs that meet the selection criteria under subsection (c). Such a 
contract shall provide that--
            (1) a Department medical provider at the medical center may 
        refer patients directly to the FQHC, without any requirement to 
        consult with other agencies, offices, or units within the 
        Department or with entities under contract with the Department;
            (2) all patient referrals to the FQHC are at the discretion 
        of the Department medical provider, and the decision whether to 
        accept such a referral will be at the discretion of the 
        patient;
            (3) if a patient accepts such a referral, the FQHC agrees 
        to accept the patient;
            (4) if the FQHC accepts the patient, the FQHC shall provide 
        medical services to the patient only to the extent that such 
        services are available from the FQHC pursuant to section 330 of 
        the Public Health Service Act (42 U.S.C. 254b);
            (5) if a patient accepted by the FQHC is a veteran, the 
        FQHC shall accept the family members of the veteran and shall 
        provide care and services to such family members in accordance 
        with chapter 17 of title 38, United States Code, if such family 
        members are eligible for medical services under such chapter;
            (6) if a patient referred under the demonstration program 
        is not eligible for a type of care or service needed by the 
        patient under chapter 17 of title 38, United States Code, the 
        FQHC agrees to provide such care or service to the patient, and 
        accept payment for such care or service, in accordance with 
        section 330 of the Public Health Service Act (42 U.S.C. 254b);
            (7) the FQHC agrees to provide to patients referred under 
        the demonstration program--
                    (A) in consultation with the Department medical 
                center, appropriate education on what care and services 
                may be provided to the patient under chapter 17 of 
                title 38, United States Code, and what care and 
                services may not be provided under such title; and
                    (B) appropriate education on what care and services 
                are provided under section 330 of the Public Health 
                Service Act (42 U.S.C. 254b) and what care and services 
                are not provided under such section;
            (8) the FQHC agrees to provide medical services to the 
        veteran in a context that sufficiently takes into account the 
        culture of members of the uniformed services, veterans, and 
        family members and caregivers of members of the uniformed 
        services and veterans, including the experience of combat and 
        the experience of military sexual trauma;
            (9) the medical center and the FQHC agree to cooperate to 
        ensure that patients referred under the demonstration program 
        are patients of both the medical center and the FQHC and, for 
        such purposes, to ensure interoperability, to the extent 
        practicable, in terms of sharing the electronic health records 
        of the patients;
            (10) the FQHC agrees to begin providing care and services 
        to a referred patient promptly after receiving the referral, 
        without regard to whether the patient has completed the process 
        of enrolling in the patient enrollment system under section 
        1705 of title 38, United States Code;
            (11) with respect to a patient who is a veteran who has not 
        completed such enrollment process as of the time the referral 
        is made, the FQHC agrees to--
                    (A) in coordination with the medical center, make 
                available to the veteran assistance with the enrollment 
                process; and
                    (B) accept that reimbursement from the Secretary 
                for providing care or services to the veteran will be 
                delayed until after the enrollment process is 
                completed;
            (12) the FQHC agrees to accept the financial risk that a 
        patient referred under the demonstration program may not 
        qualify for care or services furnished by the Secretary under 
        title 38, United States Code;
            (13) the FQHC agrees to make available to referred 
        patients, at one or more services sites of the FQHC and in 
        accordance with the limitations on the scope of services 
        applicable under section 330 of the Public Health Service Act 
        (42 U.S.C. 245b)--
                    (A) behavioral and mental health and substance 
                abuse services;
                    (B) women's health services, including OBGYN 
                services;
                    (C) audiology;
                    (D) HIV and hepatitis C treatment;
                    (E) dental care;
                    (F) optometry and ophthalmology;
                    (G) pain management;
                    (H) internal medicine;
                    (I) cancer detection and screening;
                    (J) podiatry; and
                    (K) urgent care;
            (14) the FQHC agrees to provide additional services to 
        referred patients to enable such patients to access medical 
        services furnished under the demonstration program, including 
        outreach and transportation services;
            (15) the Secretary agrees to provide timely reimbursement 
        to the FQHC for medical services, provided to referred patients 
        at the applicable rate for the State in which the FQHC is 
        located under section 1902(bb) of the Social Security Act (42 
        U.S.C. 1396a);
            (16) the FQHC agrees to undergo periodic audits in 
        accordance with section 330 of the Public Health Service Act 
        (42 U.S.C. 254b) and title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.); and
            (17) to the extent practicable, the medical center agrees 
        to provide information to patients on the availability in such 
        area of medical services through the participation of the FQHC 
        in the demonstration program, including information on the 
        particular services that are available from the FQHC and on the 
        extent to which the patient will be required to make payments 
        for such service.
    (c) Selection Criteria.--
            (1) In general.--In order to select FQHCs with which to 
        enter into contracts under subsection (b), the Secretary shall 
        develop selection criteria. Such selection criteria shall--
                    (A) take into account geographic and demographic 
                differences across catchment areas, as defined by the 
                Veterans Health Administration;
                    (B) provide for the selection of one or more FQHCs 
                that have not fewer than two service sites, including 
                one service site in a highly rural area;
                    (C) provide for the selection of one or more FQHCs 
                that--
                            (i) have a large number of service sites;
                            (ii) have a service area--
                                    (I) in which a significant number 
                                of veterans reside;
                                    (II) that includes both rural and 
                                urban areas, and one or more Department 
                                medical centers; and
                                    (III) that is located within 100 
                                miles of a military base;
                            (iii) is participating in a network that--
                                    (I) provides connectivity with 
                                respect to electronic health records; 
                                and
                                    (II) includes one or more 
                                Department medical centers as 
                                participants; and
                            (iv) has engaged in outreach to one or more 
                        Department medical centers toward collaborating 
                        on the provision of services to veterans;
                    (D) require that a selected FQHC has the capability 
                to assist veterans in navigating the benefits available 
                to them under the laws administered by the Secretary of 
                Veterans Affairs; and
                    (E) require a selected FQHC to commit to 
                establishing a program to educate health professionals 
                employed by the FQHC on cultural competency in 
                providing services to veterans.
            (2) Approval of certain fqhcs.--Each contract entered into 
        under subsection (b) shall specify the date on which the FQHC 
        agrees to begin providing medical services to patients referred 
        by a medical provider at a Department of Veterans Affairs 
        medical center under the contract. Such date may not be later 
        than 180 days after the date on which the Secretary and the 
        FQHC enter into the contract.
    (d) Coordination With Department of Health and Human Services.--In 
carrying out the demonstration program under this section, the 
Secretary of Veterans Affairs shall consult with the Secretary of 
Health and Human Services (acting through the Administrator of the 
Health Resources and Services Administration), who shall provide to the 
Secretary of Veterans Affairs information on the capacity of FQHCs to 
serve veterans. With respect to FQHCs that are participating in such 
demonstration program, the Secretary of Health and Human Services may, 
subject to that availability of appropriations for such purpose, make 
payments to such FQHCs to increase such capacity.
    (e) Patient Enrollment.--
            (1) Non-enrolled veterans.--Notwithstanding subsection (c) 
        of section 1705 of title 38, United States Code, the Secretary 
        shall develop a process to refer veterans who are not enrolled 
        in the patient enrollment system of the Department of Veterans 
        Affairs under such section to an FQHC for the provision of 
        medical services to the veteran under the pilot program.
            (2) Facilitation of enrollment.--The Secretary shall 
        develop a process by which FQHCs that have entered into a 
        contract with the Secretary under subsection (b) are able to 
        facilitate the enrollment of veterans referred to the FQHC 
        under paragraph (1) in such patient enrollment system.
    (f) Electronic Health Records.--The Secretary of Veterans Affairs 
shall provide notice to any veteran accepting a referral to an FQHC 
under the demonstration program that such acceptance shall serve as 
consent for the Department medical center and the FQHC to share 
electronic health records unless the veteran elects not to authorize 
such sharing of records using a form provided by the Secretary for such 
purpose.
    (g) Rule of Construction.--Nothing in this section shall be 
construed as affecting--
            (1) any authority or obligation of the Secretary of 
        Veterans Affairs to furnish medical services under chapter 17 
        of title 38, United States Code, to a patient who is referred 
        to an FQHC under the demonstration program;
            (2) the eligibility of any individual to receive medical 
        services under chapter 17 of title 38, United States Code; or
            (3) section 330 of the Public Health Service Act (42 U.S.C. 
        254b).
    (h) Funding.--No additional amounts are authorized to be 
appropriated to carry out this section. The Secretary shall carry out 
the demonstration program using amounts otherwise available to the 
Secretary for Medical Community Care for fiscal years 2018 through 
2022.
    (i) Duration; Termination.--
            (1) Duration.--The Secretary of Veterans Affairs may enter 
        into contracts under the demonstration program during the 
        three-year period beginning on the date of the enactment of 
        this Act. Such period may be extended or made permanent at the 
        discretion of the Secretary.
            (2) Provision of care.--If the Secretary terminates the 
        demonstration program under this section, the Secretary shall 
        ensure that patients receiving care or services through a FQHC 
        pursuant to a contract entered into under subsection (b) are 
        able to receive medical services provided by the FQHC under 
        such contract until the conclusion of the relevant episode of 
        care.
    (j) Definition of Federally Qualified Health Center.--The term 
``Federally Qualified Health Center'' means an entity receiving a grant 
under section 330 of the Public Health Service Act (42 U.S.C. 254b) or 
any other entity described in section 1861(aa)(4) of the Social 
Security Act.
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