Identification of health care providers that are not eligible to participate in Veterans Community Care Program

(a)

Plan

(1)

Requirement

Beginning not later than 90 days after the date of the enactment of this Act, the Secretary of Veterans Affairs, acting through the Under Secretary for Health, shall carry out a plan to improve the methods by which the Secretary identifies health care providers that are not eligible to participate in the Veterans Community Care Program. (2)

Matters included

The plan under paragraph (1) shall include the following: (A)Modifying the standard operating procedures of the Office of Community Care of the Veterans Health Administration regarding the exclusion of health care providers from participating in the Veterans Community Care Program to require the automated continuous matching of health care providers in the Provider Profile Management System of the Veterans Health Administration, or such successor system, with covered data systems using multiple unique identifiers, including taxpayer identification number, national provider identifier, Social Security number, and date of birth. (B)A fraud risk analysis conducted by the Office of Community Care regarding the exclusion of health care providers from participating in the Veterans Community Care Program that includes— (i)an assessment of the likelihood and impact of inherent fraud risks relating to the self-certification of State licenses and addresses provided by health care providers; (ii)a determination of the fraud risk tolerance; and (iii)an examination of the suitability of existing fraud controls. (C)Any other matters the Under Secretary determines will improve the oversight of health care providers participating in the Veterans Community Care Program. (b)

Certification

Not later than 270 days after the date of the enactment of this Act, the Secretary shall certify to the Committees on Veterans’ Affairs of the House of Representatives and the Senate that the Secretary has implemented the plan under subsection (a). (c)

Reports

(1)

Initial report

Not later than one year after the date of the enactment of this Act, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report that— (A)describes the progress the Under Secretary has made in carrying out the plan under subsection (a); and (B)includes recommendations for legislative action to further improve the methods by which the Secretary identifies health care providers that are not eligible to participate in the Veterans Community Care Program. (2)

Update

Not later than two years after the date on which the Secretary submits the report under paragraph (1), the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate an update to the report. (d)

Definitions

In this section: (1)The term covered data systems means the following: (A)The List of Excluded Individuals/Entities of the Office of Inspector General of the Department of Health and Human Services. (B)The System for Award Management Exclusions list described in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations. (C)The monthly deactivation file of the National Plan and Provider Enumeration System of the Centers for Medicare & Medicaid Services. (D)The National Practitioner Data Bank established pursuant to the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101 et seq.). (2)The term Veterans Community Care Program means the program established under section 1703 of title 38, United States Code.