[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 1279 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  1st Session
                                S. 1279

To amend title 38, United States Code, to furnish health care from the 
Department of Veterans Affairs through the use of non-Department health 
                care providers, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 25, 2017

   Mr. Crapo introduced the following bill; which was read twice and 
             referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
To amend title 38, United States Code, to furnish health care from the 
Department of Veterans Affairs through the use of 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 ``Veterans Health 
Administration Reform Act of 2017''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Establishment of Care in the Community Program.
Sec. 3. Authorization of provider agreements under Care in the 
                            Community Program.
Sec. 4. Expansion of reimbursement of veterans for emergency treatment 
                            and urgent care.
Sec. 5. Memorandum of understanding between Department of Veterans 
                            Affairs and Centers for Medicare & Medicaid 
                            Services.
Sec. 6. Education program on health care options from Department of 
                            Veterans Affairs.
Sec. 7. Training program for administration of Non-Department of 
                            Veterans Affairs health care.
Sec. 8. Analysis of electronic health record of Department of Veterans 
                            Affairs.
Sec. 9. Reports assessing effectiveness of certain positions and 
                            offices of Department of Veterans Affairs.
Sec. 10. Sense of Congress regarding reforms at the Veterans Health 
                            Administration.

SEC. 2. ESTABLISHMENT OF CARE IN THE COMMUNITY PROGRAM.

    (a) Establishment of Program.--
            (1) In general.--Section 1703 of title 38, United States 
        Code, is amended to read as follows:
``Sec. 1703. Care in the Community Program
    ``(a) In General.--(1) The Secretary may furnish care and services 
described in subsection (c) to eligible veterans described in 
subsection (b) from non-Department health care providers through the 
use of Veterans Care Agreements under section 1703A of this title, 
arrangements under subsection (d), or under any other law administered 
by the Secretary. The furnishing of care and services under this 
section may be referred to as the `Care in the Community Program'.
    ``(2) For purposes of this section, care or services `furnished by' 
the Secretary means that the Secretary authorizes the care or services 
and pays for the care or services.
    ``(3) An eligible veteran may elect to decline to receive care or 
services furnished under this section and instead receive such care or 
services at a medical facility of the Department.
    ``(b) Eligible Veterans.--(1) A veteran is an eligible veteran for 
purposes of this section if the veteran is enrolled in the system of 
annual patient enrollment established and operated under section 1705 
of this title and one or more of the following conditions apply:
            ``(A) The Secretary determines that it is in the clinical 
        best interest of the veteran to access care or services outside 
        of the Department.
            ``(B) The veteran would experience an undue burden if the 
        veteran seeks care or services from the Department.
            ``(C) It is not economical for the Department to provide 
        the veteran the care or services that the veteran needs.
    ``(2) A determination by the Secretary under paragraph (1)(A) shall 
include an assessment of factors relating to the medical or clinical 
condition of the veteran and the timeliness of the Department in 
providing the care or services required by the veteran.
    ``(3) For purposes of paragraph (1)(B), an undue burden--
            ``(A) means--
                    ``(i) an excessive driving distance, geographical 
                challenges, or environmental factors impede the access 
                of the veteran to care or services from the Department; 
                or
                    ``(ii) the care or services sought by the veteran 
                are not provided by a medical facility of the 
                Department that is reasonably accessible to the 
                veteran; and
            ``(B) may include other circumstances as determined by the 
        Secretary upon assessing--
                    ``(i) the nature or complexity of the care or 
                services that the veteran requires;
                    ``(ii) the frequency with which the veteran 
                requires such care or services; and
                    ``(iii) the need for an attendant to provide 
                required aid or physical assistance to the veteran for 
                the veteran to travel to a medical facility of the 
                Department.
    ``(c) Care and Services Described.--Care and services described in 
this subsection are the following:
            ``(1) Hospital care.
            ``(2) Medical services.
            ``(3) Diagnostic care.
            ``(4) With respect to veterans described in section 
        1712(a)(1)(F) of this title, outpatient dental services and 
        treatment and related dental appliances.
            ``(5) Such other care or services as determined by the 
        Secretary.
    ``(d) Arrangements.--(1) The Secretary may provide care and 
services under this section through arrangements described in paragraph 
(2).
    ``(2) Arrangements described in this paragraph are the following:
            ``(A) Health care coordination and sharing activities with 
        the Department of Defense under section 8111 of this title.
            ``(B) Arrangements under section 8153 of this title.
            ``(C) Arrangements between the Secretary and the Director 
        of the Indian Health Service.
            ``(D) Agreements under section 1745 of this title.
            ``(E) Agreements with Federally-qualified health centers 
        (as defined in section 1905(l)(2)(B) of the Social Security Act 
        (42 U.S.C. 1396d(l)(2)(B))).
    ``(3) Nothing in this section may be construed to modify the way 
the Department, other Federal agencies, and States determine 
responsibility for payment under arrangements described in paragraph 
(2).
    ``(e) Prohibition on Collection of Payment.--A health care provider 
that provides care or services under this section shall agree not to 
recover or collect payment from--
            ``(1) an eligible veteran in connection with care or 
        services furnished under this section; or
            ``(2) a health-plan contract or other third party on behalf 
        of the eligible veteran in connection with such care or 
        services.
    ``(f) Electronic Waiting List for Care at Department Facilities.--
(1) If an eligible veteran seeks care or services under this section, 
the Secretary shall provide the veteran an opportunity to be included 
on an electronic waiting list maintained by the Department for an 
appointment for care or services described in subsection (c) at a 
medical facility of the Department.
    ``(2) The electronic waiting list maintained under paragraph (1) 
shall allow access by each eligible veteran via www.myhealth.va.gov or 
any successor website (or other digital channel) for the following 
purposes:
            ``(A) To determine the place of such eligible veteran on 
        the waiting list.
            ``(B) To determine the average length of time an individual 
        spends on the waiting list, disaggregated by medical facility 
        of the Department and type of care or service needed, for 
        purposes of allowing such eligible veteran to make an informed 
        election to receive care or services under this section or at a 
        medical facility of the Department.
    ``(g) Information on Availability of Care.--The Secretary shall 
provide information to a veteran about the availability of care and 
services under this section in the following circumstances:
            ``(1) When the veteran enrolls in the system of annual 
        patient enrollment established and operated under section 1705 
        of this title.
            ``(2) When the veteran attempts to schedule an appointment 
        for the receipt of care or services described in subsection (c) 
        from the Department but is unable to schedule an appointment 
        within the wait-time goals of the Veterans Health 
        Administration for the furnishing of such care or services.
            ``(3) When the veteran becomes eligible for care or 
        services under this section under subparagraph (A), (B), or (C) 
        of subsection (b)(1).
    ``(h) Follow-Up Care.--In carrying out this section, the Secretary 
shall ensure that, at the election of an eligible veteran who receives 
care or services from a health care provider in an episode of care 
under this section, the veteran receives such care or services from 
such health care provider through the completion of the episode of care 
(but for a period not exceeding one year), including all specialty and 
ancillary services deemed necessary as part of the treatment 
recommended in the course of such care or services.
    ``(i) Cost Sharing.--(1) The Secretary shall require an eligible 
veteran to pay a copayment for the receipt of care or services under 
this section only if such eligible veteran would be required to pay a 
copayment for the receipt of such care or services at a medical 
facility of the Department or from a health care provider of the 
Department.
    ``(2) The amount of a copayment charged under paragraph (1) may not 
exceed the amount of the copayment that would be payable by such 
eligible veteran for the receipt of such care or services at a medical 
facility of the Department or from a health care provider of the 
Department.
    ``(j) Administration of Program.--(1) The Non-VA Care Coordination 
Program of the Department, working jointly with the Chief Business 
Office of the Department, shall administer the Care in the Community 
Program under this section.
    ``(2) Administration of the Care in the Community Program shall 
include the following:
            ``(A) Ensuring that an eligible veteran receives an 
        appointment for care or services under this section within--
                    ``(i) the wait-time goals of the Veterans Health 
                Administration; or
                    ``(ii) the period that a health care provider of 
                the veteran at the Department determines the care or 
                services are needed.
            ``(B) Ensuring that the Secretary, including any 
        contractors of the Secretary, pay health care providers on 
        time.
            ``(C) Ensuring that medical information of an eligible 
        veteran who receives care or services under this section is 
        sent to the health care provider of the veteran at the 
        Department.
            ``(D) Ensuring that the Secretary has information regarding 
        any other health insurance of an eligible veteran.
    ``(3) The Secretary shall ensure that the Non-VA Care Coordination 
Program of the Department and the Chief Business Office of the 
Department are working together effectively and efficiently throughout 
the process of furnishing care under this section.
    ``(4) The Secretary shall notify the Committee on Veterans' Affairs 
of the Senate and the Committee on Veterans' Affairs of the House of 
Representatives if any functions under this subsection require 
alteration or realignment.
    ``(k) Payment of Claims.--(1) The Secretary shall ensure that all 
payments of claims under this section comply with chapter 39 of title 
31 (commonly referred to as the `Prompt Payment Act') and the 
requirements of this subsection. If there is a conflict between the 
requirements of the Prompt Payment Act and the requirements of this 
subsection, the Secretary shall comply with the requirements of this 
subsection.
    ``(2)(A) Payment by the Secretary of claims under this section 
shall be issued, mailed, or otherwise transmitted with respect to not 
less than 95 percent of all such claims within 30 days after the date 
on which the claim is received, if--
            ``(i) the claim is a clean claim; and
            ``(ii) the claim is not one for which payment is made on a 
        periodic interim payment basis.
    ``(B) In this paragraph, the term `clean claim' means a claim that 
has no defect or impropriety (including any lack of any required 
substantiating documentation) or particular circumstance requiring 
special treatment that prevents timely payment from being made on the 
claim under this section.
    ``(3)(A) The Secretary is the primary payer for all care or 
services furnished under this section.
    ``(B) The Secretary may recover or collect reasonable charges for 
care or services furnished under this section from a third party 
pursuant to section 1729 of this title or any other provision of law 
that would permit the Secretary to recover or collect the cost of care 
furnished at a facility of the Department or under the laws 
administered by the Secretary.
    ``(l) Online Portal.--The Secretary shall establish an online 
portal that health care providers participating in the Care in the 
Community Program may use as follows:
            ``(1) To submit medical information with respect to 
        eligible veterans furnished care or services under this 
        section.
            ``(2) To file claims for payment for care or services 
        furnished under this section.
            ``(3) To monitor the status of payment of claims under this 
        section, including whether or not the claim was approved or 
        rejected.
            ``(4) To determine whether the Secretary requires 
        additional information before processing the claim.
    ``(m) Annual Report on Contract Care.--(1) Not later than April 1 
each year, the Secretary shall submit to the Committee on Veterans' 
Affairs of the Senate and the Committee on Veterans' Affairs of the 
House of Representatives a report on health care contracted for under 
the laws administered by the Secretary, including under the Care in the 
Community Program.
    ``(2) Each report submitted under paragraph (1) shall--
            ``(A) describe the use by the Secretary of Veterans Care 
        Agreements under section 1703A of this title, arrangements 
        under subsection (e), and other contracts or agreements for 
        health care under this section or any other law administered by 
        the Secretary;
            ``(B) state the number of such agreements, arrangements, or 
        contracts entered into and the costs of such agreements, 
        arrangements, or contracts, disaggregated by medical center of 
        the Department; and
            ``(C) include an assessment by the Central Office of the 
        Veterans Health Administration of the efforts of such office to 
        coordinate such agreements, arrangements, or contracts.
    ``(n) Rule of Construction.--Nothing in this section or section 
1703A of this title shall be construed to prevent the Secretary from 
entering into regional or national contracts to provide prescription 
medication, dialysis treatment, prosthetics, and such other care or 
services under this section as the Secretary considers appropriate.''.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 17 of such title is amended by striking 
        the item related to section 1703 and inserting the following 
        new item:

``1703. Care in the Community Program.''.
            (3) Report on development and implementation of online 
        portal.--
                    (A) In general.--Not later than December 31, 2017, 
                the Under Secretary for Health of the Department of 
                Veterans Affairs shall submit to Congress a report on 
                the development and implementation by the Department of 
                Veterans Affairs of the online portal established under 
                subsection (m) of section 1703 of title 38, United 
                States Code, as added by paragraph (1), for the 
                processing of claims by health care providers under the 
                Care in the Community Program under such section.
                    (B) Elements.--The report required by subparagraph 
                (A) shall include the following:
                            (i) A detailed schedule for developing and 
                        implementing the online portal described in 
                        subparagraph (A).
                            (ii) An assessment of whether the online 
                        portal includes the following elements:
                                    (I) Automatic adjudication of 
                                claims.
                                    (II) Automated entry of 
                                authorizations for care or services.
                                    (III) A mechanism by which health 
                                care providers can electronically 
                                submit medical records, including 
                                health care providers that a veteran 
                                may have seen without authorization 
                                from the Department.
                                    (IV) A web-based portal for health 
                                care providers to check the status of 
                                their claims.
                            (iii) Estimated costs for developing and 
                        implementing each aspect of the online portal.
                            (iv) Performance goals, measures, and 
                        interim milestones that the Under Secretary for 
                        Health will use to evaluate progress, hold 
                        staff accountable for achieving desired 
                        results, and report to stakeholders on the 
                        impact of the online portal in modernizing the 
                        claims processing system of the Department.
    (b) Conforming Amendments.--
            (1) Dental care.--Section 1712(a)(3) of title 38, United 
        States Code, is amended, in paragraph (3), by striking ``under 
        clause (1), (2), or (5) of section 1703(a) of this title'' and 
        inserting ``under section 1703 of this title''.
            (2) Readjustment counseling.--Section 1712A(e)(1) of such 
        title is amended by striking ``sections 1703(a)(2) and 
        1710(a)(1)(B) of this title'' and inserting ``sections 1703 and 
        1710(a)(1)(B) of this title''.
            (3) Conforming repeal of superseded authority.--
                    (A) In general.--Section 101 of the Veterans 
                Access, Choice, and Accountability Act of 2014 (Public 
                Law 113-146; 38 U.S.C. 1701 note) is repealed.
                    (B) Conforming amendment.--Section 208 of such Act 
                is amended--
                            (i) in paragraph (1), by striking 
                        ``hospital care and medical services under 
                        section 101'' and inserting ``care and services 
                        under section 1703 of title 38, United States 
                        Code''; and
                            (ii) in paragraph (2), by striking 
                        ``hospital care and medical services'' and 
                        inserting ``care and services''.
    (c) Repeal of Authority To Contract for Scarce Medical 
Specialists.--
            (1) In general.--Section 7409 of title 38, United States 
        Code, is repealed.
            (2) Clerical amendment.--The table of sections at the 
        beginning of chapter 74 of such title is amended by striking 
        the item relating to section 7409.

SEC. 3. AUTHORIZATION OF PROVIDER AGREEMENTS UNDER CARE IN THE 
              COMMUNITY 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. Care in the Community Program: provider agreements
    ``(a) Agreements To Furnish Care.--The Secretary may furnish care 
and services under the Care in the Community Program under section 1703 
of this title by entering into agreements under this section with 
eligible providers that are certified under subsection (c).
    ``(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.--The Secretary shall 
establish a process for the certification of eligible providers under 
this section.
    ``(d) Rates for Care and Services.--(1) Except as otherwise 
provided in this subsection, an eligible provider that enters into an 
agreement under this section to provide care or services under section 
1703 of this title shall agree to accept as payment in full for such 
care or services an amount equal to the rate 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.
    ``(2)(A) A higher rate than the rate paid by the United States as 
described in paragraph (1) may be negotiated with respect to the 
furnishing of care or services to a veteran who resides in a highly 
rural area.
    ``(B) In this paragraph, the term `highly rural area' means an area 
located in a county that has fewer than seven individuals residing in 
that county per square mile.
    ``(3) With respect to furnishing care or services under this 
subsection in Alaska, the Alaska Fee Schedule of the Department of 
Veterans Affairs shall be followed, except for when another payment 
agreement, including a contract or provider agreement, is in place.
    ``(4) With respect to furnishing care or services under this 
subsection in a State with an All-Payer Model Agreement under section 
1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that 
became effective on January 1, 2014, the Medicare payment rates under 
subparagraph (A) shall be calculated based on the payment rates under 
such agreement.
    ``(5) With respect to furnishing care or services under this 
subsection for which there is not a rate paid under the Medicare 
program as described in paragraph (1), such as dental care, obstetrics 
and gynecology, and other services, the rate paid for such care or 
services shall be determined by the Secretary.
    ``(6) In determining rates and making payments under this 
subsection, the Secretary may conduct pilot programs on alternative 
payment systems similar to those used under the Medicare program, 
including the Merit-based Incentive Payment System under section 
1848(q) of the Social Security Act (42 U.S.C. 1395w-4(q)) and 
alternative payment models (as defined in section 1833(z)(3)(C) of the 
Social Security Act (42 U.S.C. 1395l(z)(3)(C))).
    ``(7) If a higher rate than the rate specified in paragraph (1) is 
determined under this subsection, the Secretary shall notify the 
Centers for Medicare & Medicaid Services regarding such higher rate.
    ``(e) Treatment of Certain Laws.--(1) An agreement under this 
section may be entered into without regard to any contracting 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 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 contracting law that an eligible provider described in 
subsection (b)(1), (b)(2), or (b)(3) is not subject to under the 
original Medicare fee-for-service program under parts A and B of title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) or the 
Medicaid program under title XIX of such Act (42 U.S.C. 1396 et seq.).
    ``(B) The exclusion under subparagraph (A) does not apply to laws 
regarding integrity, ethics, fraud, or that subject a person to civil 
or criminal penalties.
    ``(3) Title VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et 
seq.) shall apply with respect to an eligible provider that enters into 
an agreement under this section to the same extent as such title 
applies with respect to the eligible provider in providing care or 
services through an agreement or arrangement other than under this 
section.''.
    (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. Care in the Community Program: provider agreements.''.

SEC. 4. 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) Cost Sharing.--(1) The Secretary shall require a veteran to 
pay a copayment for the receipt of emergency treatment or urgent care 
under this section only if such veteran would be required to pay a 
copayment for the receipt of such treatment or care at a medical 
facility of the Department or from a health care provider of the 
Department.
    ``(2) The amount of a copayment charged to a veteran under 
paragraph (1) may not exceed the amount of the copayment that would be 
payable by such veteran for the receipt of emergency treatment or 
urgent care at a medical facility of the Department or from a health 
care provider of the Department.
    ``(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. 5. MEMORANDUM OF UNDERSTANDING BETWEEN DEPARTMENT OF VETERANS 
              AFFAIRS AND CENTERS FOR MEDICARE & MEDICAID SERVICES.

    (a) Sense of Congress.--It is the sense of Congress that the 
Secretary of Veterans Affairs should ensure that a veteran who is 
enrolled in Medicare or Medicaid, is eligible for care or services 
under the Care in the Community Program under section 1703 of title 38, 
United States Code, as amended by section 2(a)(1), and seeks care or 
services for a non-service-connected disability or condition, knows 
that the veteran may use his or her benefits under Medicare or Medicaid 
before the Secretary authorizes the use of funds of the Department of 
Veterans Affairs.
    (b) Purpose.--The purpose of this section is to facilitate 
coordination and communication between the Department of Veterans 
Affairs and the Centers for Medicare & Medicaid Services for the 
benefit of veterans in the receipt of health care.
    (c) Memorandum of Understanding.--
            (1) In general.--The Secretary of Veterans Affairs and the 
        Administrator of the Centers for Medicare & Medicaid Services 
        shall enter into a memorandum of understanding regarding the 
        coordination of care between the Department of Veterans Affairs 
        and the Centers for Medicare & Medicaid Services.
            (2) Referral of patients.--
                    (A) In general.--The memorandum of understanding 
                under paragraph (1) shall permit health care providers 
                of the Department of Veterans Affairs to refer veterans 
                eligible for benefits under Medicare or Medicaid to 
                non-Department health care providers in the community 
                to use the Medicare or Medicaid benefits of such 
                veterans.
                    (B) Treatment of referral.--Referral of a veteran 
                under subparagraph (A) does not authorize the Secretary 
                of Veterans Affairs--
                            (i) to use funds of the Department of 
                        Veterans Affairs to conduct the referral or pay 
                        for care or services furnished pursuant to such 
                        a referral; or
                            (ii) to furnish care or services to the 
                        veteran under the Care in the Community Program 
                        under section 1703 of title 38, United States 
                        Code, as amended by section 2(a)(1).
            (3) Sharing of information.--As part of the memorandum of 
        understanding under paragraph (1), the Secretary and the 
        Administrator shall agree to share information in connection 
        with the coordination of care under such memorandum, including 
        by establishing a mechanism to share patient information.
            (4) Technical assistance for care in the community 
        program.--
                    (A) In general.--As part of the memorandum of 
                understanding under paragraph (1), the Administrator 
                may provide technical assistance to the Secretary 
                regarding the development of a program for non-
                Department health care providers to submit claims for 
                reimbursement electronically under the Care in the 
                Community Program under section 1703 of title 38, 
                United States Code, as amended by section 2(a)(1).
                    (B) Interoperability and safety of information.--In 
                providing technical assistance under subparagraph (A), 
                the Administrator shall provide advice regarding 
                interoperability and methods for safeguarding the 
                security of patient information.
                    (C) Use of assistance.--The Secretary shall use any 
                technical assistance provided under subparagraph (A) in 
                the development of a web-based self-service portal for 
                non-Department health care providers to be used under 
                subsection (l) of section 1703 of title 38, United 
                States Code, as amended by section 2(a)(1).
    (d) Education Program.--
            (1) In general.--The Secretary of Veterans Affairs and the 
        Administrator of the Centers for Medicare & Medicaid Services 
        shall jointly develop and administer an education program to 
        inform veterans how their benefits from the Department of 
        Veterans Affairs are separate from and interact with their 
        benefits under Medicare or Medicaid.
            (2) Elements of program.--The education program under 
        paragraph (1) shall--
                    (A) assist veterans in making informed decisions 
                about when to use benefits from the Department and when 
                to use benefits under Medicare or Medicaid;
                    (B) provide information on which services require 
                referrals from the Department and which services 
                require no referral; and
                    (C) explain any financial costs that may be 
                required to receive care, including copayments under 
                Medicare or from the Department.
            (3) Use of memorandum of understanding.--The education 
        program under paragraph (1) may be implemented pursuant to the 
        memorandum of understanding under subsection (c).
    (e) Rule of Construction.--This section may not be construed to 
authorize or require the Secretary of Veterans Affairs to reimburse the 
Administrator of the Centers for Medicare & Medicaid Services for 
health care services or for the Administrator to reimburse the 
Secretary for such services.
    (f) Definitions.--In this section:
            (1) Medicaid.--The term ``Medicaid'' means the Medicaid 
        program under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.).
            (2) Medicare.--The term ``Medicare'' means the Medicare 
        program under title XVIII of such Act (42 U.S.C. 1395 et seq.).
            (3) Non-service-connected.--The term ``non-service-
        connected'' has the meaning given that term in section 101 of 
        title 38, United States Code.

SEC. 6. EDUCATION PROGRAM ON HEALTH CARE OPTIONS FROM DEPARTMENT OF 
              VETERANS AFFAIRS.

    (a) In General.--The Secretary of Veterans Affairs shall develop 
and administer an education program that teaches veterans about their 
health care options through the Department of Veterans Affairs.
    (b) Elements.--The program under subsection (a) shall--
            (1) teach veterans about--
                    (A) eligibility criteria for care from the 
                Department set forth under section 1710 of title 38, 
                United States Code;
                    (B) priority groups for enrollment in the system of 
                annual patient enrollment under section 1705(a) of such 
                title; and
                    (C) the copayments and other financial obligations, 
                if any, required of certain individuals for certain 
                services;
            (2) teach veterans about the interaction between health 
        insurance (including private insurance, Medicare, Medicaid, the 
        TRICARE program, and other forms of insurance) and health care 
        from the Department; and
            (3) provide veterans information on what to do when they 
        have a complaint about health care received from the Department 
        (whether about the doctor, the Department, or any other type of 
        complaint).
    (c) Inclusion of Information From Education Program on Medicare and 
Medicaid.--The education program under this section shall include 
information from the education program under section 6(d).
    (d) Accessibility.--In developing the education program under this 
section, the Secretary shall ensure that materials under such program 
are accessible to veterans who may not have access to the Internet.
    (e) Definitions.--In this section:
            (1) Medicaid.--The term ``Medicaid'' means the Medicaid 
        program under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.).
            (2) Medicare.--The term ``Medicare'' means the Medicare 
        program under title XVIII of such Act (42 U.S.C. 1395 et seq.).
            (3) TRICARE program.--The term ``TRICARE program'' has the 
        meaning given that term in section 1072 of title 10, United 
        States Code.

SEC. 7. TRAINING PROGRAM FOR ADMINISTRATION OF NON-DEPARTMENT OF 
              VETERANS AFFAIRS HEALTH CARE.

    (a) In General.--The Secretary of Veterans Affairs shall develop 
and implement a training program to train employees and contractors of 
the Department of Veterans Affairs on how to administer non-Department 
health care programs, including the following:
            (1) Reimbursement for non-Department emergency room and 
        urgent care under section 1725 of title 38, United States Code.
            (2) The Care in the Community Program under section 1703 of 
        such title, as amended by section 2(a)(1).
    (b) Inclusion of Training on Cooperation With Centers for Medicare 
& Medicaid Services.--The training program under subsection (a) shall 
include training on coordinating care between the Department and 
Medicare and Medicaid, including pursuant to the memorandum of 
understanding between the Secretary of Veterans Affairs and the 
Administrator of the Centers for Medicare & Medicaid Services under 
section 6(a).
    (c) Definitions.--In this section:
            (1) Medicaid.--The term ``Medicaid'' means the Medicaid 
        program under title XIX of the Social Security Act (42 U.S.C. 
        1396 et seq.).
            (2) Medicare.--The term ``Medicare'' means the Medicare 
        program under title XVIII of such Act (42 U.S.C. 1395 et seq.).

SEC. 8. ANALYSIS OF ELECTRONIC HEALTH RECORD OF DEPARTMENT OF VETERANS 
              AFFAIRS.

    (a) In General.--The Chief Information Officer of the Veterans 
Health Administration, in partnership with the Chief Information 
Officer of the Department of Veterans Affairs, shall conduct a 
comprehensive cost-benefit analysis among selecting a commercial off-
the-shelf electronic health record, selecting an open source electronic 
health record, or continuing the in-house custom development of the 
VistA electronic health record currently in use by the Veterans Health 
Administration.
    (b) Elements.--The analysis conducted under subsection (a) shall--
            (1) take into account the complexities of the computerized 
        patient record system architecture and infrastructure of the 
        VistA electronic health record and known issues with 
        performance, scalability, extensibility, interoperability, and 
        security of such health record; and
            (2) address full life-cycle costs, including development 
        time (based on recent delivery trends), availability of 
        development resources, maintenance and licensing costs, and 
        infrastructure costs.
    (c) Report.--
            (1) Initial report.--Not later than September 30, 2017, the 
        Secretary of Veterans Affairs shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives a report on the 
        progress of the analysis conducted under subsection (a).
            (2) Final report.--Not later than December 31, 2017, the 
        Secretary shall submit to the Committee on Veterans' Affairs of 
        the Senate and the Committee on Veterans' Affairs of the House 
        of Representatives the results of the analysis conducted under 
        subsection (a).

SEC. 9. REPORTS ASSESSING EFFECTIVENESS OF CERTAIN POSITIONS AND 
              OFFICES OF DEPARTMENT OF VETERANS AFFAIRS.

    (a) Report on CIO of Veterans Health Administration.--
            (1) In general.--Not later than December 31, 2017, the 
        Secretary of Veterans Affairs shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives a report assessing 
        whether the Chief Information Officer of the Veterans Health 
        Administration serves as an effective advocate for the 
        information technology needs of the Department of Veterans 
        Affairs for health care delivery.
            (2) Elements.--The report required by paragraph (1) shall 
        include a description of the requirements for an effective 
        health care management system that would advance the mission 
        and goals of the Veterans Health Administration.
            (3) Use of information.--In preparing the report under 
        paragraph (1), the Secretary shall include information from the 
        Under Secretary for Health of the Department of Veterans 
        Affairs and the Chief Information Officer of the Department of 
        Veterans Affairs.
    (b) Report on Office of Information and Technology.--
            (1) In general.--Not later than December 31, 2017, the 
        Secretary of Veterans Affairs shall submit to the Committee on 
        Veterans' Affairs of the Senate and the Committee on Veterans' 
        Affairs of the House of Representatives a report assessing 
        whether the Office of Information and Technology of the 
        Department of Veterans Affairs acts as a service provider and 
        delivers information technology capabilities and services that 
        improve health care delivery to veterans.
            (2) Use of survey data.--In preparing the report under 
        paragraph (1), the Secretary shall include the results of 
        clinician and veteran surveys assessing the quality of and 
        satisfaction with capabilities and services of the Department.

SEC. 10. SENSE OF CONGRESS REGARDING REFORMS AT THE VETERANS HEALTH 
              ADMINISTRATION.

    (a) Findings.--Congress finds that section 201 of the Veterans 
Access, Choice, and Accountability Act of 2014 (Public Law 113-146; 38 
U.S.C. 1701 note) required an independent assessment of the hospital 
care, medical services, and other health care furnished in medical 
facilities of the Department of Veterans Affairs. That assessment 
provided valuable insight into needed reforms at the Veterans Health 
Administration, particularly with respect to governance, operations, 
data and tools, and leadership.
    (b) Sense of Congress.--
            (1) In general.--It is the sense of Congress that the 
        Secretary of Veterans Affairs should take every effort to 
        address as many of the reforms described in subsection (a) as 
        practicable.
            (2) Elements.--In making reforms described in subsection 
        (a), it is the sense of Congress that the Secretary should do 
        the following:
                    (A) Improve the overall management of the Veterans 
                Health Administration as follows:
                            (i) By ensuring that the Administration 
                        provides the decision making rights, 
                        authorities, and responsibilities to the lowest 
                        appropriate level. Such decision making rights, 
                        authorities, and responsibilities should be 
                        articulated by level, organization, and role, 
                        and should be standardized to the extent 
                        possible while allowing local flexibility based 
                        on local needs.
                            (ii) By clarifying the roles and 
                        responsibilities of the Central Office of the 
                        Administration, the Veterans Integrated Service 
                        Networks, the medical centers of the 
                        Department, the community-based outpatient 
                        clinics of the Department, and other 
                        organizational entities, while prioritizing 
                        providing support to the field.
                            (iii) By reassessing all of the directed 
                        metrics and policies of the Central Office of 
                        the Administration to ensure those metrics and 
                        policies add sufficient value to patient 
                        outcomes. The Secretary should eliminate the 
                        metrics and policies that do not add sufficient 
                        value to patient outcomes.
                            (iv) By reviewing the implementation of the 
                        Patient Aligned Care Team staffing model of the 
                        Department, including by determining areas for 
                        improvement, to examine--
                                    (I) causes of gaps in facility 
                                benchmarks between actual, maximum, 
                                modeled, and external benchmarks; and
                                    (II) impacts on access to quality 
                                of care and appropriateness of 
                                performance standards and guidelines.
                    (B) Improve collaboration between the Office of 
                Information and Technology of the Department and the 
                Veterans Health Administration.
                    (C) Improve resource management and business 
                processes by--
                            (i) prioritizing the use of a patient-
                        centered demand model that forecasts resources 
                        needed by geographic location to improve access 
                        and make informed resourcing decisions; and
                            (ii) improving coordination across patient 
                        access, clinical administration, and patient 
                        accounting functions by forming an internal 
                        committee of key revenue cycle and 
                        administrative stakeholders, standardizing the 
                        recovery processes for billing, improving 
                        third-party contracts management, and 
                        developing approaches to resolve frequently 
                        recurring denials.
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