79–006 

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: 

2 

1 VA National Transplant Program. https://www.va.gov/health/services/transplant/ Accessed 

October 30, 2017 2 Ibid. 

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

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 

3 

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. 

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. 

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 

4 

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. 

5 

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. 

6 

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 transVerDate Sep 11 2014 05:49 Nov 09, 2017 Jkt 079006 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR395.XXX HR395
7 

plant. 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: 

8 

(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, inVerDate Sep 11 2014 05:49 Nov 09, 2017 Jkt 079006 PO 00000 Frm 00008 Fmt 6659 Sfmt 6602 E:\HR\OC\HR395.XXX HR395
9 

cluding 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); øor¿ 

(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 

Secretaryø.¿; 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— 

10 

(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. 

11 

(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: 

12 

(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.— 

13 

(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: 

14 

(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. 

15 

(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 enVerDate Sep 11 2014 05:49 Nov 09, 2017 Jkt 079006 PO 00000 Frm 00015 Fmt 6659 Sfmt 6602 E:\HR\OC\HR395.XXX HR395
16 

sure 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 

17 

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 ADMINISTRA- TION.— 

(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. 

* * * * * * * 

Æ