Pilot program for market-based rate adjustments for qualifying specialized surgical services under the Veterans Community Care Program

(a)

In general

Commencing not later than one year after the date of the enactment of this Act, the Secretary of Veterans Affairs shall carry out a pilot program to permit qualified providers to negotiate market-based rate adjustments for furnishing qualifying specialized surgical services to veterans under the Veterans Community Care Program (in this section referred to as the pilot program).(b)

Duration

The Secretary may carry out the pilot program for the five-year period beginning on the commencement of the pilot program.(c)

Locations

The Secretary shall carry out the pilot program in not less than two Veterans Integrated Service Networks of the Department of Veterans Affairs with a large number of veterans residing in locations that are in rural or highly rural areas.(d)

Determination of market-Based rate adjustments

In carrying out the pilot program, the Secretary shall provide a market-based rate adjustment to a qualified provider in furnishing qualified specialized surgical services to a veteran if—(1)the provider demonstrates that the rate adjustment is necessary to furnish such services;(2)the rate otherwise applicable to such services under the Veterans Community Care Program is insufficient to cover the cost of furnishing such services; and(3)the veteran lives in a geographical area where there are no other qualifying specialized surgical services furnished by the Department of Veterans Affairs, either direct care or through the Veterans Community Care Program, available within either a 60-day wait-time or distance of 100 miles.(e)

Regulations

Not later than 180 days after the date of the enactment of this Act, the Secretary shall prescribe, through notice and comment rulemaking, regulations necessary to implement this section.(f)

Inspector General review

Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter for the duration of the pilot program, the Inspector General of the Department of Veterans Affairs shall—(1)conduct a review of the pilot program to ensure compliance by the Secretary with requirements under the pilot program and to ensure the efficiency and effectiveness of the pilot program; and(2)submit to the Secretary and the appropriate committees of Congress a report containing the findings from such review.(g)

Annual report

Not later than one year after the date of the enactment of this Act, and not less frequently than annually thereafter for the duration of the pilot program, the Secretary shall submit to the appropriate committees of Congress a report on the pilot program that includes, for the year covered by the report, the following:(1)The number of patients served under the pilot program.(2)The different types of qualifying specialized surgical services furnished under the pilot program and the number of veterans furnished each such service.(3)The total costs incurred in furnishing services under the pilot program.(4)A description of any measurable outcomes in terms of health results for patients under the pilot program.(5)Any policy recommendations for improvement of the pilot program or recommendations as to whether the pilot program should be extended or made permanent.(6)Such other information as the Secretary determines relevant to include.(h)

Definitions

In this section:(1)

Appropriate committees of Congress

The term appropriate committees of Congress means—(A)the Committee on Veterans’ Affairs of the Senate; and(B)the Committee on Veterans’ Affairs of the House of Representatives.(2)

Qualified provider

The term qualified provider means a board-certified surgeon.(3)

Qualifying specialized surgical services

The term qualifying specialized surgical services means services relating to neurosurgery.(4)

Veterans Community Care Program

The term Veterans Community Care Program means the program under section 1703 of title 38, United States Code.