[Congressional Record Volume 162, Number 91 (Thursday, June 9, 2016)]
[Senate]
[Pages S3738-S3740]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 4636. Mr. McCAIN submitted an amendment intended to be proposed by
him to the bill S. 2943, to authorize appropriations for fiscal year
2017 for military activities of the Department of Defense, for military
construction, and for defense activities of the Department of Energy,
to prescribe military personnel strengths for such fiscal year, and for
other purposes; which was ordered to lie on the table; as follows:
At the end of subtitle I of title X, add the following:
SEC. 1097. ESTABLISHMENT OF VETERANS CHOICE PROGRAM.
(a) Establishment of Program.--
(1) 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. Veterans Choice Program
``(a) Program.--
``(1) Furnishing of care.--
``(A) In general.--Subject to the availability of
appropriations provided for such purpose, hospital care and
medical services under this chapter may be furnished to an
eligible veteran described in subsection (b), at the election
of such veteran, through contracts authorized under
subsection (d), or any other law administered by the
Secretary, with entities specified in subparagraph (B) for
the furnishing of such care and services to veterans. The
furnishing of hospital care and medical services under this
section may be referred to as the `Veterans Choice Program'.
``(B) Entities specified.--The entities specified in this
subparagraph are the following:
``(i) Any health care provider that is participating in the
Medicare program under title XVIII of the Social Security Act
(42 U.S.C. 1395 et seq.), including any physician furnishing
services under such program.
``(ii) Any Federally-qualified health center (as defined in
section 1905(l)(2)(B) of the Social Security Act (42 U.S.C.
1396d(l)(2)(B))).
``(iii) The Department of Defense.
``(iv) The Indian Health Service.
``(v) Any health care provider not otherwise covered under
any of clauses (i) through (iv) that meets criteria
established by the Secretary for purposes of this section.
``(2) Choice of provider.--An eligible veteran who makes an
election under subsection (c) to receive hospital care or
medical services under this section may select a provider
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of such care or services from among the entities specified in
paragraph (1)(B) that are accessible to the veteran.
``(3) Coordination of care and services.--The Secretary
shall coordinate, through the Non-VA Care Coordination
Program of the Department, the furnishing of care and
services under this section to eligible veterans, including
by ensuring that an eligible veteran receives an appointment
for such care and services within the wait-time goals of the
Veterans Health Administration for the furnishing of hospital
care and medical services.
``(b) Eligible Veterans.--A veteran is an eligible veteran
for purposes of this section if--
``(1) the veteran is enrolled in the patient enrollment
system of the Department established and operated under
section 1705 of this title; and
``(2)(A) the veteran is unable to schedule an appointment
for the receipt of hospital care or medical services from a
health care provider of the Department within the lesser of--
``(i) the wait-time goals of the Veterans Health
Administration for such care or services; or
``(ii) a period determined by a health care provider of the
Department to be clinically necessary for the receipt of such
care or services;
``(B) the veteran does not reside within 40 miles driving
distance from a medical facility of the Department, including
a community-based outpatient clinic, with a full-time primary
care physician;
``(C) the veteran--
``(i) resides in a State without a medical facility of the
Department that provides--
``(I) hospital care;
``(II) emergency medical services; and
``(III) surgical care rated by the Secretary as having a
surgical complexity of standard; and
``(ii) does not reside within 20 miles driving distance
from a medical facility of the Department described in clause
(i);
``(D) the veteran faces an unusual or excessive burden in
accessing hospital care or medical services from a medical
facility of the Department that is within 40 miles driving
distance from the residence of the veteran due to--
``(i) geographical challenges;
``(ii) environmental factors, such as roads that are not
accessible to the general public, traffic, or hazardous
weather;
``(iii) a medical condition of the veteran that affects the
ability to travel; or
``(iv) such other factors as determined by the Secretary;
``(E) the veteran resides in a location, other than a
location in Guam, American Samoa, or the Republic of the
Philippines, that requires the veteran to travel by air,
boat, or ferry to reach a medical facility of the Department,
including a community-based outpatient clinic;
``(F) the veteran is enrolled in the pilot program under
section 403 of the Veterans' Mental Health and Other Care
Improvements Act of 2008 (Public Law 110-387; 38 U.S.C. 1703
note) as of the date of the enactment of the National Defense
Authorization Act for Fiscal Year 2017; or
``(G) there is a compelling reason, as determined by the
Secretary, that the veteran needs to receive hospital care or
medical services from a medical facility other than a medical
facility of the Department.
``(c) Election and Authorization.--
``(1) In general.--In the case of an eligible veteran
described in subsection (b)(2)(A), the Secretary shall, at
the election of the veteran--
``(A) provide the veteran an appointment that exceeds the
wait-time goals described in such subsection or place such
veteran on an electronic waiting list described in paragraph
(2) for an appointment for hospital care or medical services
the veteran has elected to receive under this section; or
``(B)(i) authorize that such care or services be furnished
to the eligible veteran under this section; and
``(ii) notify the eligible veteran by the most effective
means available, including electronic communication or
notification in writing, describing the care or services the
eligible veteran is eligible to receive under this section.
``(2) Electronic waiting list.--The electronic waiting list
described in this paragraph shall be maintained by the
Department and 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 under paragraph (1).
``(d) Care and Services Through Contracts.--
``(1) Contracts.--
``(A) In general.--Except as provided in subparagraph (B)
and subject to the availability of appropriations provided
for such purpose, the Secretary may enter into contracts for
furnishing care and services to eligible veterans under this
section with entities specified in subsection (a)(1)(B).
``(B) Other processes.--Before entering into a contract
under this paragraph, the Secretary shall, to the maximum
extent practicable and consistent with the requirements of
this section, furnish such care and services to such veterans
under this section with such entities pursuant to sharing
agreements, existing contracts entered into by the Secretary,
or other processes available at medical facilities of the
Department.
``(C) Treatment of contracts.--A contract entered into
under this paragraph may not be treated as a Federal contract
for the acquisition of goods or services and is not subject
to any provision of law governing Federal contracts for the
acquisition of goods or services.
``(D) Contract defined.--In this paragraph, the term
`contract' has the meaning given that term in subpart 2.101
of the Federal Acquisition Regulation.
``(2) Rates and reimbursement.--
``(A) In general.--In entering into a contract under
paragraph (1) with an entity specified in subsection
(a)(1)(B), the Secretary shall--
``(i) negotiate rates for the furnishing of care and
services under this section; and
``(ii) reimburse the entity for such care and services at
the rates negotiated under clause (i) as provided in such
contract.
``(B) Limit on rates.--
``(i) In general.--Except as provided in clause (ii), rates
negotiated under subparagraph (A)(i) shall not be more than
the rates 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.
``(ii) Exceptions.--
``(I) In general.--The Secretary may negotiate a rate that
is more than the rate paid by the United States as described
in clause (i) with respect to the furnishing of care or
services under this section to an eligible veteran who
resides in a highly rural area.
``(II) Other exceptions.--
``(aa) Alaska.--With respect to furnishing care or services
under this section in Alaska, the Alaska Fee Schedule of the
Department of Veterans Affairs will be followed, except for
when another payment agreement, including a contract or
provider agreement, is in place.
``(bb) Other states.--With respect to care or services
furnished under this section in a State with an All-Payer
Model Agreement in effect under section 1814 of the Social
Security Act (42 U.S.C. 1395f), the Medicare payment rates
under clause (i) shall be calculated based on the payment
rates under such agreement.
``(III) Highly rural area defined.--In this clause, 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.
``(C) Limit on collection.--For the furnishing of care or
services pursuant to a contract under paragraph (1), an
entity specified in subsection (a)(1)(B) may not collect any
amount that is greater than the rate negotiated pursuant to
subparagraph (A)(i).
``(e) Veterans Choice Card.--
``(1) In general.--For purposes of receiving care and
services under this section, the Secretary shall issue to
each veteran described in subsection (b)(1) a card that may
be presented to a health care provider to facilitate the
receipt of care or services under this section.
``(2) Name of card.--Each card issued under paragraph (1)
shall be known as a `Veterans Choice Card'.
``(3) Details of card.--Each Veterans Choice Card issued to
a veteran under paragraph (1) shall include the following:
``(A) The name of the veteran.
``(B) An identification number for the veteran that is not
the social security number of the veteran.
``(C) The contact information of an appropriate office of
the Department for health care providers to confirm that care
or services under this section are authorized for the
veteran.
``(D) Contact information and other relevant information
for the submittal of claims or bills for the furnishing of
care or services under this section.
``(E) The following statement: `This card is for qualifying
medical care outside the Department of Veterans Affairs.
Please call the Department of Veterans Affairs phone number
specified on this card to ensure that treatment has been
authorized.'.
``(4) Information on use of card.--Upon issuing a Veterans
Choice Card to a veteran, the Secretary shall provide the
veteran with information clearly stating the circumstances
under which the veteran may be eligible for care or services
under this section.
``(f) 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 patient enrollment
system of the Department established and operated under
section 1705 of this title.
``(2) When the veteran attempts to schedule an appointment
for the receipt of hospital care or medical services 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.
[[Page S3740]]
``(3) When the veteran becomes eligible for hospital care
or medical services under this section under subparagraph
(B), (C), (D), (E), (F), or (G) of subsection (b)(2).
``(g) Follow-Up Care.--The Secretary shall ensure that, at
the election of an eligible veteran who receives hospital
care or medical services from a health care provider in an
episode of care under this section, the veteran receives such
care or services from that health care provider or another
health care provider selected by the veteran, including a
health care provider of the Department, through the
completion of the episode of care, including all specialty
and ancillary services deemed necessary as part of the
treatment recommended in the course of such care or services.
``(h) Providers.--To be eligible to furnish care or
services under this section, a health care provider must--
``(1) maintain at least the same or similar credentials and
licenses as those credentials and licenses that are required
of health care providers of the Department, as determined by
the Secretary for purposes of this section; and
``(2) submit, not less frequently than annually,
verification of such licenses and credentials maintained by
such health care provider.
``(i) Cost-Sharing.--
``(1) In general.--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 under this
chapter.
``(2) Limitation.--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 under this
chapter.
``(j) Claims Processing System.--
``(1) In general.--The Secretary shall provide for an
efficient nationwide system for prompt processing and paying
of bills or claims for authorized care and services furnished
to eligible veterans under this section.
``(2) Oversight.--The Chief Business Office of the Veterans
Health Administration shall oversee the implementation and
maintenance of such system.
``(3) Accuracy of payment.--
``(A) In general.--The Secretary shall ensure that such
system meets such goals for accuracy of payment as the
Secretary shall specify for purposes of this section.
``(B) Quarterly report.--
``(i) In general.--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 quarterly report on the accuracy of such
system.
``(ii) Elements.--Each report required by clause (i) shall
include the following:
``(I) A description of the goals for accuracy for such
system specified by the Secretary under subparagraph (A).
``(II) An assessment of the success of the Department in
meeting such goals during the quarter covered by the report.
``(iii) Deadline.--The Secretary shall submit each report
required by clause (i) not later than 20 days after the end
of the quarter covered by the report.
``(k) Medical Records.--
``(1) In general.--The Secretary shall ensure that any
health care provider that furnishes care or services under
this section to an eligible veteran submits to the Department
a copy of any medical record related to the care or services
provided to such veteran by such health care provider for
inclusion in the electronic medical record of such veteran
maintained by the Department upon the completion of the
provision of such care or services to such veteran.
``(2) Electronic format.--Any medical record submitted to
the Department under paragraph (1) shall, to the extent
possible, be in an electronic format.
``(l) Records Not Required for Reimbursement.--With respect
to care or services furnished to an eligible veteran by a
health care provider under this section, the receipt by the
Department of a medical record under subsection (k) detailing
such care or services is not required before reimbursing the
health care provider for such care or services.
``(m) Tracking of Missed Appointments.--The Secretary shall
implement a mechanism to track any missed appointments for
care or services under this section by eligible veterans to
ensure that the Department does not pay for such care or
services that were not furnished to an eligible veteran.
``(n) Rules of Construction.--
``(1) Prescription medications.--Nothing in this section
shall be construed to alter the process of the Department for
filling and paying for prescription medications.
``(2) Tiered network.--Nothing in this section shall be
construed to authorize the creation of a tiered network in
which an eligible veteran would be required to receive care
or services from an entity in a higher tier than any other
entity or provider network.
``(o) Wait-Time Goals of the Veterans Health
Administration.--
``(1) In general.--Except as provided in paragraph (2), in
this section, the term `wait-time goals of the Veterans
Health Administration' means not more than 30 days from the
date on which a veteran requests an appointment for hospital
care or medical services from the Department.
``(2) Alternate goals.--If the Secretary submits to
Congress, not later than 180 days after the date of the
enactment of the National Defense Authorization Act for
Fiscal Year 2017, a report stating that the actual wait-time
goals of the Veterans Health Administration are different
from the wait-time goals specified in paragraph (1)--
``(A) for purposes of this section, the wait-time goals of
the Veterans Health Administration shall be the wait-time
goals submitted by the Secretary under this paragraph; and
``(B) the Secretary shall publish such wait-time goals in
the Federal Register and on an Internet website of the
Department available to the public.
``(p) Waiver of Certain Printing Requirements.--Section 501
of title 44 shall not apply in carrying out this section.
``(q) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section $3,500,000,000.
``(r) Termination.--The Secretary may not furnish hospital
care or medical services under this section after January 31,
2019.''.
(2) Clerical amendment.--The table of sections at the
beginning of chapter 17 of such title is amended by inserting
after the item relating to section 1703 the following new
item:
``1703A. Veterans Choice Program.''.
(3) Source of amounts.--All amounts required to carry out
section 1703A of title 38, United States Code, as added by
paragraph (1), shall be derived from the appropriations
account described in section 4003 of the Surface
Transportation and Veterans Health Care Choice Improvement
Act of 2015 (Public Law 114-41; 38 U.S.C. 1701 note).
(b) Effective Date.--The amendments made by subsection (a)
shall take effect on the date that is 180 days after the date
of the enactment of this Act.
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