[House Report 115-395]
[From the U.S. Government Publishing Office]
115th Congress } { REPORT
HOUSE OF REPRESENTATIVES
1st Session } { 115-395
======================================================================
VETERANS INCREASED CHOICE FOR TRANSPLANTED ORGANS AND RECOVERY ACT OF
2017
_______
November 7, 2017.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 2601]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 2601) to amend the Veterans Access, Choice, and
Accountability Act of 2014 to improve the access of veterans to
organ transplants, and for other purposes, having considered
the same, reports favorably thereon with an amendment and
recommends that the bill as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 4
Committee Consideration.......................................... 4
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 5
New Budget Authority, Entitlement Authority, and Tax Expenditures 5
Earmarks and Tax and Tariff Benefits............................. 5
Committee Cost Estimate.......................................... 5
Congressional Budget Office Estimate............................. 5
Federal Mandates Statement....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Statement on Duplication of Federal Programs..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 7
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Veterans Increased Choice for
Transplanted Organs and Recovery Act of 2017'' or the ``VICTOR Act of
2017''.
SEC. 2. ORGAN TRANSPLANTS UNDER THE VETERANS CHOICE PROGRAM.
Section 101(b)(2) of the Veterans Access, Choice, and Accountability
Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended--
(1) in subparagraph (C)(ii), by striking ``or'';
(2) in subparagraph (D)(ii)(II)(dd), by striking the period and
inserting ``; or''; and
(3) by adding at the end the following new subparagraph:
``(E)(i) requires an organ or bone marrow transplant; and
``(ii)(I) has, in the opinion of the primary health care provider
of the veteran, a medically compelling reason to travel outside the
region of the Organ Procurement and Transplantation Network,
established under section 372 of the National Organ Transplantation Act
(Public Law 98-507; 42 U.S.C. 274), in which the veteran resides to
receive such transplant at a medical facility of the Department; or
``(II) faces an unsual or excessive burden in receiving such
transplant at a medical facility of the Department, including--
``(aa) geographical challenges;
``(bb) environmental factors, including roads that are not
accessible to the general public, traffic, or hazardous weather;
``(cc) a medical condition of the veteran that affects the
ability to travel; or
``(dd) other factors the Secretary determines appropriate,
including the preference of the veteran to receive such transplant at a
non-Department facility.''.
SEC. 3. EFFECTIVE DATE.
The amendments made by this Act shall take effect on the later of--
(1) October 1, 2018; and
(2) the date of the enactment of this Act.
Purpose and Summary
H.R. 2601, as amended, the ``Veterans Increased Choice for
Transplanted Organs and Recovery Act of 2017,'' would authorize
the Department of Veterans Affairs (VA) to provide for any care
or services for transplantation to a veteran who requires an
organ transplant at a federally approved transplant center that
treats Medicare patients if there are compelling medical
reasons for the veteran to go outside of his Organ Procurement
and Transplantation Network, or the veteran faces an unusual or
excessive burden in receiving his transplantation care at a VA
Transplantation Center (VATC).
Background and Need for Legislation
VA has offered solid organ transplant services for eligible
veteran patients since 1962 and bone marrow transplant services
for eligible veteran patients since 1982.\1\ Through VA's
National Transplant Program, VA provides transplants primarily
through 13 VA transplant centers located in: Palo Alto,
California; Portland, Oregon; Seattle, Washington; Houston,
Texas; San Antonio, Texas; Salt Lake City, Utah; Iowa City,
Iowa; Madison, Wisconsin; Birmingham, Alabama; Nashville,
Tennessee; West Roxbury, Massachusetts; Bronx, New York;
Pittsburgh, Pennsylvania; and Richmond, Virginia.\2\
---------------------------------------------------------------------------
\1\VA National Transplant Program. https://www.va.gov/health/
services/transplant/ Accessed October 30, 2017
\2\Ibid.
---------------------------------------------------------------------------
The Veterans Access, Choice, and Accountability Act of 2014
(Public Law 113-146; 128 STAT. 1754) created the Choice program
to increase access to care in the community for veteran
patients unable to receive care at VA medical facilities due to
long waiting times for VA appointments or lengthy travel
distances to VA medical facilities. Since the implementation of
the Choice program, the Committee has been hearing an
increasing number of complaints about the VA transplant program
from veterans who are concerned about the lengthy travel
required for many veterans to reach a VA transplant center and
barriers to receiving transplant care in the community.
Currently, a veteran who needs an organ transplant must obtain
the transplant at one of the fourteen VATCs. This means that a
veteran may be required to travel hundreds, even thousands of
miles across several states for a transplant, despite
potentially bypassing many other transplant centers on the way.
On June 29, 2016, the Journal of the American Medical
Association published an article that found that greater
distance from a VA Transplant Center was associated with a
lower likelihood of receiving a transplant and a greater
likelihood of death among certain veteran transplant
patients.\3\ Moreover, there may be medical reasons for which a
veteran would benefit from going to a particular transplant
center regardless of where the veteran resides. Given that, the
Committee believes that veterans residing far from VA
transplant centers should be given the option of receiving
their transplant from transplant centers that would most
benefit the veteran. The Committee also believes that, wherever
possible, VA should remove barriers to transplant care in the
community for veteran patients. Consistent with those goals,
section 2 of the bill would authorize VA to provide for any
care or services a veteran may need, for a bone marrow or a
solid organ transplant, at a federally approved transplant
center if, in the opinion of the veteran's primary care
physician, the veteran has a compelling reason to travel
outside of the region of the Organ Procurement and
Transplantation Network in which the veteran resides, or if the
veteran faces an unusual or excessive burden at a VATC
including geographical challenges, environmental factors, a
medical condition of the veteran that affects the ability to
travel, and other factors determined appropriate by the
Secretary of VA, including the veteran's preference to receive
a transplant at a non-VA facility.
---------------------------------------------------------------------------
\3\Journal of the American Medical Association, ``Association of
Distance from a Transplant Center with Access to Waitlist Placement,
Receipt of Liver Transplantation, and Survival Among U.S. Veterans,
June 29, 2016, https://www.ncbi.nlm.nih.gov/pubmed/24668105.
---------------------------------------------------------------------------
Hearings
There were no Subcommittee hearings held on H.R. 2601.
On October 24, 2017, the full Committee conducted a
legislative hearing on a number of bills including H.R. 2601.
The following witnesses testified:
The Honorable Jim Banks, U.S. House of
Representatives, 3rd District, Indiana; The Honorable
Mike Gallagher, U.S. House of Representatives, 8th
District, Wisconsin; The Honorable John R. Carter, U.S.
House of Representatives, 31st District, Texas; The
Honorable Glenn Thompson, U.S. House of
Representatives, 5th District, Pennsylvania; The
Honorable Neal P. Dunn, U.S. House of Representatives,
2nd District, Florida; The Honorable Andy Barr, U.S.
House of Representatives, 6th District, Kentucky; The
Honorable David J. Shulkin, M.D., Secretary, U.S.
Department of Veterans Affairs, who was accompanied by
Carolyn Clancy M.D., the Executive in Charge of the
Veterans Health Administration, and Laurie Zephyrin
M.D., MPH, MBA, the Acting Deputy Under Secretary for
Health for Community Care for the Veterans Health
Administration; Adrian M. Atizado, Deputy National
Legislative Director, Disabled American Veterans;
Roscoe G. Butler, Deputy Director for Health Care,
Veterans Affairs and Rehabilitation Division, The
American Legion; and Kayda Keleher, Associate Director,
National Legislative Service, Veterans of Foreign Wars
of the United States.
Statements for the record were submitted by:
American Federation of Government Employees, AFL-CIO;
American Health Care Association; American Medical
Association; AMVETS; Concerned Veterans of America;
Fleet Reserve Association; Got Your 6; Health IT Now;
Iraq and Afghanistan Veterans of America; Military
Officers Association of America; Military Order of the
Purple Heart; National Alliance on Mental Illness;
National Guard Association of the United States; Nurses
Organization of Veterans Affairs/Association of VA
Psychologist Leaders/Association of VA Social Workers/
Veterans Healthcare Action Campaign; Paralyzed Veterans
of America; Reserve Officers Association; University of
Pittsburgh; Vietnam Veterans of America; and the
Wounded Warrior Project.
Subcommittee Consideration
There was no Subcommittee consideration of H.R. 2601, as
amended.
Committee Consideration
On November 2, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 1133, as
amended, to be reported favorably to the House of
Representatives by voice vote. During consideration of the
bill, the following amendments were considered and agreed to by
voice vote:
An Amendment in the Nature of a Substitute to H.R.
2601 offered by Representative Neal Dunn of Florida.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 1133,
as amended, reported to the House. A motion by Representative
Tim Walz of Minnesota, Ranking Member of the Committee on
Veterans' Affairs, to report H.R. 1133, as amended, favorably
to the House of Representatives was agreed to by voice vote.
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII and clause
(2)(b)(1) of rule X of the Rules of the House of
Representatives, the Committee's oversight findings and
recommendations are reflected in the descriptive portions of
this report.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are to improve the provision of transplant
care to veteran patients by authorizing VA to provide for any
care or services a live donor may require to carry out a
transplant procedure in either a VA or VA community care
facility for an eligible veteran notwithstanding that the live
donor may not be eligible for VA health care.
New Budget Authority, Entitlement Authority, and Tax Expenditures
With respect to the requirement with respect to clause
3(c)(2) of rule XIII of the Rules of the House of
Representatives, the Committee has requested but not received
from the Director of the Congressional Budget Office an
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues.
Earmarks and Tax and Tariff Benefits
H.R. 2601, as amended, does not contain any Congressional
earmarks, limited tax benefits, or limited tariff benefits as
defined in clause 9 of rule XXI of the Rules of the House of
Representatives.
Committee Cost Estimate
Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
this bill.
However, clause 3(d)(3)(B) of that Rule provides that this
requirement does not apply when the Committee has included in
its report a timely submitted cost estimate of the bill
prepared by the Director of the Congressional Budget Office
under section 402 of the Congressional Budget Act of 1974. The
Committee has requested but not received a cost estimate for
this bill from the Director of the Congressional Budget Office.
The Committee believes, according to a preliminary score from
the Congressional Budget Office, that enactment of H.R. 2601,
as amended, would not increase outlays from the current amounts
appropriated to the Veterans Choice Fund.
Budget Authority and Congressional Budget Office Cost Estimate
With respect to the requirements of clause 3(c)(2) of rule
XIII of the Rules of the House of Representatives and section
308(a) of the Congressional Budget Act of 1974 and with respect
to requirements of clause (3)(c)(3) of rule XIII of the Rules
of the House of Representatives and section 402 of the
Congressional Budget Act of 1974, the Committee has requested
but not received a cost estimate for this bill from the
Director of Congressional Budget Office. The Committee has
requested but not received from the Director of the
Congressional Budget Office a statement as to whether this bill
contains any new budget authority, spending authority, credit
authority, or an increase or decrease in revenues or tax
expenditures.
Federal Mandates Statement
With respect to the requirements of Section 423 of the
Congressional Budget and Impoundment Control Act (as amended by
Section 101(a)(2) of the Unfunded Mandate Reform Act, P.L. 104-
4), the Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether the provisions of the reported bill include unfunded
mandates.
Advisory Committee Statement
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act would be created by H.R.
1133, as amended.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 2601, as amended, is authorized by Congress'
power to ``provide for the common Defense and general Welfare
of the United States.''
Applicability to Legislative Branch
The Committee finds that H.R. 2601, as amended, does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 115th Cong. (2017),
the Committee finds that no provision of H.R. 2601, as amended,
establishes or reauthorizes a program of the Federal Government
known to be duplicative of another Federal program, a program
that was included in any report from the Government
Accountability Office to Congress pursuant to section 21 of
Public Law 111-139, or a program related to a program
identified in the most recent Catalog of Federal Domestic
Assistance.
Disclosure of Directed Rulemaking
Pursuant to section 3(i) of H. Res. 5, 115th Cong. (2017),
the Committee estimates that H.R. 2601, as amended, contains no
directed rulemaking that would require the Secretary to
prescribe regulations.
Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 of the bill would provide the short title for
H.R. 2601, as amended, as the ``Veterans Increased Choice for
Transplanted Organs and Recovery Act of 2017'' or the ``VICTOR
Act of 2017''.
Section 2. Organ transplants under the Veterans Choice program
Section 2 of the bill would amend Section 101(b)(2) of the
Veterans Access, Choice, and Accountability Act of 2014 (PL
113-146) by adding, at the end, a new section (D)(ii)(II)(dd)
with regards to the eligibility of a veteran seeking an organ
or bone marrow transplant. The new section would authorize VA,
in the case in which a veteran is eligible for a transplant
procedure from VA, to authorize medical care and services via
the Choice program when: (1) in the opinion of the primary
health care provider of the veteran, there exists a compelling
reason to travel outside the region of the Organ Procurement
and Transplantation Network in which the veteran resides to
receive such a transplant at a medical facility of the
Department; or (2) if the veteran faces an unusual or excessive
burden in receiving a transplant at a Department medical
facility. Unusual or Excessive burdens include: geographic
challenges; environmental factors, including roads that are not
accessible to the general public, traffic, or hazardous
weather; a medical condition of the veteran that affects the
ability to travel; or other factors determined appropriate by
the Secretary, to include the veterans preference.
Section 3. Effective date
Section 3 of the bill would stipulate that amendments made
by this Act shall take effect on October 1, 2018, or the date
of enactment whichever occurs later.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, and existing law in which no
change is proposed is shown in roman):
VETERANS ACCESS, CHOICE, AND ACCOUNTABILITY ACT OF 2014
* * * * * * *
TITLE I--IMPROVEMENT OF ACCESS TO CARE FROM NON-DEPARTMENT OF VETERANS
AFFAIRS PROVIDERS
SEC. 101. EXPANDED AVAILABILITY OF HOSPITAL CARE AND MEDICAL SERVICES
FOR VETERANS THROUGH THE USE OF AGREEMENTS WITH
NON-DEPARTMENT OF VETERANS AFFAIRS ENTITIES.
(a) Expansion of Available Care and Services.--
(1) Furnishing of care.--
(A) In General.--Hospital care and medical
services under chapter 17 of title 38, United
States Code, shall be furnished to an eligible
veteran described in subsection (b), at the
election of such veteran, through agreements
authorized under subsection (d), or any other
law administered by the Secretary of Veterans
Affairs, with entities specified in
subparagraph (B) for the furnishing of such
care and services to veterans.
(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) Subject to subsection (d)(5), a
health care provider not otherwise
covered under any of clauses (i)
through (iv).
(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 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 of Veterans Affairs, 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 of Veterans Affairs
established and operated under section 1705 of title
38, United States Code, including any such veteran who
has not received hospital care or medical services from
the Department and has contacted the Department seeking
an initial appointment from the Department for the
receipt of such care or services; and
(2) the veteran--
(A) attempts, or has attempted, to schedule
an appointment for the receipt of hospital care
or medical services under chapter 17 of title
38, United States Code, but is unable to
schedule an appointment within--
(i) the wait-time goals of the
Veterans Health Administration for the
furnishing of such care or services; or
(ii) with respect to such care or
services that are clinically necessary,
the period determined necessary for
such care or services if such period is
shorter than such wait-time goals;
(B) resides more than 40 miles (as calculated
based on distance traveled) from--
(i) with respect to a veteran who is
seeking primary care, a medical
facility of the Department, including a
community-based outpatient clinic, that
is able to provide such primary care by
a full-time primary care physician; or
(ii) with respect to a veteran not
covered under clause (i), the medical
facility of the Department, including a
community-based outpatient clinic, that
is closest to the residence of the
veteran;
(C) resides--
(i) 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) more than 20 miles from a
medical facility of the Department
described in clause (i); [or]
(D)(i) resides in a location, other than a
location in Guam, American Samoa, or the
Republic of the Philippines, that is 40 miles
or less from a medical facility of the
Department, including a community-based
outpatient clinic; and
(ii)(I) is required to travel by air, boat,
or ferry to reach each medical facility
described in clause (i) that is 40 miles or
less from the residence of the veteran; or
(II) faces an unusual or excessive
burden in traveling to such a medical
facility of the Department based on--
(aa) geographical challenges;
(bb) environmental factors,
such as roads that are not
accessible to the general
public, traffic, or hazardous
weather;
(cc) a medical condition that
impacts the ability to travel;
or
(dd) other factors, as
determined by the Secretary[.];
or
(E)(i) requires an organ or bone marrow
transplant; and
(ii)(I) has, in the opinion of the primary
health care provider of the veteran, a
medically compelling reason to travel outside
the region of the Organ Procurement and
Transplantation Network, established under
section 372 of the National Organ
Transplantation Act (Public Law 98-507; 42
U.S.C. 274), in which the veteran resides to
receive such transplant at a medical facility
of the Department; or
(II) faces an unusual or excessive burden in
receiving such transplant at a medical facility
of the Department, including--
(aa) geographical challenges;
(bb) environmental factors, including
roads that are not accessible to the
general public, traffic, or hazardous
weather;
(cc) a medical condition of the
veteran that affects the ability to
travel; or
(dd) other factors the Secretary
determines appropriate, including the
preference of the veteran to receive
such transplant at a non-Department
facility.
(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 eligible veteran--
(A) provide the veteran an appointment that
exceeds the wait-time goals described in such
subsection or place such eligible 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 for a period of time specified by the
Secretary; 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 Agreements.--
(1) Agreements.--
(A) In general.--The Secretary shall enter
into agreements for furnishing care and
services to eligible veterans under this
section with entities specified in subsection
(a)(1)(B). An agreement entered into pursuant
to this subparagraph 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. Before
entering into an agreement pursuant to this
subparagraph, 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.
(B) Agreement defined.--In this paragraph,
the term ``agreement'' includes contracts,
intergovernmental agreements, and provider
agreements, as appropriate.
(2) Rates and reimbursement.--
(A) In general.--In entering into an
agreement 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 pursuant to clause (i) as
provided in such agreement.
(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) Exception.--
(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) 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.
(III) Other exceptions.--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. With respect to care or
services furnished under this
section in a State with an All-
Payer Model Agreement under the
Social Security Act that became
effective on January 1, 2014,
the Medicare payment rates
under clause (i) shall be
calculated based on the payment
rates under such agreement.
(C) Limit on collection.--For the furnishing
of care or services pursuant to an agreement
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).
(3) Certain procedures.--
(A) In general.--In entering into an
agreement under paragraph (1) with an entity
described in subparagraph (B), the Secretary
may use the procedures, including those
procedures relating to reimbursement, available
for entering into provider agreements under
section 1866(a) of the Social Security Act (42
U.S.C. 1395cc(a)) and participation agreements
under section 1842(h) of such Act (42 U.S.C.
1395u(h)). During the period in which such
entity furnishes care or services pursuant to
this section, such entity may not be treated as
a Federal contractor or subcontractor by the
Office of Federal Contract Compliance Programs
of the Department of Labor by virtue of
furnishing such care or services.
(B) Entities described.--The entities
described in this subparagraph are the
following:
(i) In the case of the Medicare
program, any provider of services that
has entered into a provider agreement
under section 1866(a) of the Social
Security Act (42 U.S.C. 1395cc(a)) and
any physician or other supplier who has
entered into a participation agreement
under section 1842(h) of such Act (42
U.S.C. 1395u(h)); and
(ii) In the case of the Medicaid
program, any provider participating
under a State plan under title XIX of
such Act (42 U.S.C. 1396 et seq.).
(4) Information on policies and procedures.--The
Secretary shall provide to any entity with which the
Secretary has entered into an agreement under paragraph
(1) the following:
(A) Information on applicable policies and
procedures for submitting bills or claims for
authorized care or services furnished to
eligible veterans under this section.
(B) Access to a telephone hotline maintained
by the Department that such entity may call for
information on the following:
(i) Procedures for furnishing care
and services under this section.
(ii) Procedures for submitting bills
or claims for authorized care and
services furnished to eligible veterans
under this section and being reimbursed
for furnishing such care and services.
(iii) Whether particular care or
services under this section are
authorized, and the procedures for
authorization of such care or services.
(5) Agreements with other providers.--In accordance
with the rates determined pursuant to paragraph (2),
the Secretary may enter into agreements under paragraph
(1) for furnishing care and services to eligible
veterans under this section with an entity specified in
subsection (a)(1)(B)(v) if the entity meets criteria
established by the Secretary for purposes of this
section.
(e) Responsibility for Costs of Certain Care.--
(1) Submittal of information on health-care plans.--
Before receiving hospital care or medical services
under this section, an eligible veteran shall provide
to the Secretary information on any health-care plan
described in paragraph (2) under which the eligible
veteran is covered.
(2) Health-care plan.--A health-care plan described
in this paragraph--
(A) is an insurance policy or contract,
medical or hospital service agreement,
membership or subscription contract, or similar
arrangement not administered by the Secretary
of Veterans Affairs, under which health
services for individuals are provided or the
expenses of such services are paid; and
(B) does not include any such policy,
contract, agreement, or similar arrangement
pursuant to title XVIII or XIX of the Social
Security Act (42 U.S.C. 1395 et seq.) or
chapter 55 of title 10, United States Code.
(3) Recovery of costs for certain care.--
(A) In general.--In any case in which an
eligible veteran is furnished hospital care or
medical services under this section for a non-
service-connected disability described in
subsection (a)(2) of section 1729 of title 38,
United States Code, or for a condition for
which recovery is authorized or with respect to
which the United States is deemed to be a third
party beneficiary under Public Law 87-693,
commonly known as the ``Federal Medical Care
Recovery Act'' (42 U.S.C. 2651 et seq.), the
Secretary shall recover or collect from a third
party (as defined in subsection (i) of such
section 1729) reasonable charges for such care
or services to the extent that the veteran (or
the provider of the care or services) would be
eligible to receive payment for such care or
services from such third party if the care or
services had not been furnished by a department
or agency of the United States.
(B) Use of amounts.--Amounts collected by the
Secretary under subparagraph (A) shall be
deposited in the Medical Community Care account
of the Department. Amounts so deposited shall
remain available until expended.
(f) Veterans Choice Card.--
(1) In general.--For purposes of receiving care and
services under this section, the Secretary shall, not
later than 90 days after the date of the enactment of
this Act, 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.
(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 patient
enrollment system of the Department under section 1705
of title 38, United States Code.
(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.
(3) When the veteran becomes eligible for hospital
care or medical services under this section under
subparagraph (B), (C), or (D) of subsection (b)(2).
(h) Follow-Up Care.--In carrying out this section, 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 hospital care and medical services
from such health care provider 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 hospital care or medical services.
(i) 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 once each year
during the period in which the Secretary is authorized
to carry out this section pursuant to subsection (p),
verification of such licenses and credentials
maintained by such health care provider.
(j) 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 pursuant to chapter 17 of
title 38, United States Code.
(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 pursuant to chapter 17
of title 38, United States Code.
(3) Collection of copayment.--A health care provider
that furnishes care or services to an eligible veteran
under this section shall collect the copayment required
under paragraph (1) from such eligible veteran at the
time of furnishing such care or services.
(k) Claims processing system.--
(1) In general.--The Secretary shall provide for an
efficient nationwide system for processing and paying
bills or claims for authorized care and services
furnished to eligible veterans under this section.
(2) Regulations.--Not later than 90 days after the
date of the enactment of this Act, the Secretary of
Veterans Affairs shall prescribe regulations for the
implementation of such system.
(3) Oversight.--The Chief Business Office of the
Veterans Health Administration shall oversee the
implementation and maintenance of such system.
(4) 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.
(l) 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 eligible veteran
by such health care provider for inclusion in the
electronic medical record of such eligible veteran
maintained by the Department upon the completion of the
provision of such care or services to such eligible
veteran.
(2) Electronic format.--Any medical record submitted
to the Department under paragraph (1) shall, to the
extent possible, be in an electronic format.
(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) Implementation.--Not later than 90 days after the date of
the enactment of this Act, the Secretary shall prescribe
interim final regulations on the implementation of this section
and publish such regulations in the Federal Register.
(o) Inspector General Report.--Not later than 30 days after
the date on which the Secretary determines that 75 percent of
the amounts deposited in the Veterans Choice Fund established
by section 802 have been exhausted, the Inspector General of
the Department shall submit to the Secretary a report on the
results of an audit of the care and services furnished under
this section to ensure the accuracy and timeliness of payments
by the Department for the cost of such care and services,
including any findings and recommendations of the Inspector
General.
(p) Authority To Furnish Care and Services.--
(1) In general.--The Secretary may not use the
authority under this section to furnish care and
services after the date specified in paragraph (2).
(2) Date specified.--The date specified in this
paragraph is the date on which the Secretary has
exhausted all amounts deposited in the Veterans Choice
Fund established by section 802.
(3) Publication.--The Secretary shall publish such
date in the Federal Register and on an Internet website
of the Department available to the public not later
than 30 days before such date.
(q) Reports.--
(1) Initial report.--Not later than 90 days after the
publication of the interim final regulations under
subsection (n), 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 the furnishing of care and
services under this section that includes the
following:
(A) The number of eligible veterans who have
received care or services under this section.
(B) A description of the types of care and
services furnished to eligible veterans under
this section.
(2) Final report.--Not later than 30 days after the
date on which the Secretary determines that 75 percent
of the amounts deposited in the Veterans Choice Fund
established by section 802 have been exhausted, 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 the
furnishing of care and services under this section that
includes the following:
(A) The total number of eligible veterans who
have received care or services under this
section, disaggregated by--
(i) eligible veterans described in
subsection (b)(2)(A);
(ii) eligible veterans described in
subsection (b)(2)(B);
(iii) eligible veterans described in
subsection (b)(2)(C); and
(iv) eligible veterans described in
subsection (b)(2)(D).
(B) A description of the types of care and
services furnished to eligible veterans under
this section.
(C) An accounting of the total cost of
furnishing care and services to eligible
veterans under this section.
(D) The results of a survey of eligible
veterans who have received care or services
under this section on the satisfaction of such
eligible veterans with the care or services
received by such eligible veterans under this
section.
(E) An assessment of the effect of furnishing
care and services under this section on wait
times for appointments for the receipt of
hospital care and medical services from the
Department.
(F) An assessment of the feasibility and
advisability of continuing furnishing care and
services under this section after the
termination date specified in subsection (p).
(r) Rule of Construction.--Nothing in this section shall be
construed to alter the process of the Department for filling
and paying for prescription medications.
(s) 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 60 days after the date of the
enactment of this Act, 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.
(t) Waiver of Certain Printing Requirements.--Section 501 of
title 44, United States Code, shall not apply in carrying out
this section.
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