[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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