I 

114TH CONGRESS 

1ST SESSION H. R. 4103 

To amend title 38, United States Code, to improve the provision of medical 

care to veterans at critical access hospitals. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 19, 2015 

Mr. CRAMER introduced the following bill; which was referred to the Committee on Veterans’ Affairs, and in addition to the Committee on Ways 

and Means, for a period to be subsequently determined by the Speaker, 

in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title 38, United States Code, to improve the 

provision of medical care to veterans at critical access 

hospitals. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Critical Access Hos5 pitals for Veterans Act’’ or the ‘‘CAHV Act’’. 

6 SEC. 2. CARE TO VETERANS AT CRITICAL ACCESS HOS7 PITALS. 

8 (a) AGREEMENT BETWEEN HHS AND VA.— 


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1 (1) IN GENERAL.—Chapter 17 of title 38, 

2 United States Code, is amended by inserting after 

3 section 1703 the following new section: 

4 ‘‘§ 1703A. Care at critical access hospitals 

5 ‘‘(a) FURNISHING OF CARE.—At the election of a vet6 eran enrolled in the health care system established under 

7 section 1705(a) of this title, hospital care and medical 

8 services shall be furnished at critical access hospitals to 

9 the veteran pursuant to the agreement described in sub10 section (b)(1). 

11 ‘‘(b) AGREEMENT.—(1) The agreement described in 

12 this paragraph is an agreement entered into by the Sec13 retary of Veterans Affairs and the Secretary of Health and 

14 Human Services under which— 

15 ‘‘(A) the Secretary of Health and Human Serv16 ices, acting through the Centers for Medicare & 

17 Medicaid Services, shall, notwithstanding any other 

18 provision of law— 

19 ‘‘(i) ensure that a critical access hospital 

20 may submit claims to the Centers for Medicare 

21 & Medicaid Services for hospital care and med22 ical services that are inpatient critical access 

23 hospital services and outpatient critical access 

24 hospital services (as such terms are defined in 

25 paragraphs (2) and (3), respectively, of section 


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1 1861(mm) of the Social Security Act (42 

2 U.S.C. 1395x(mm))) furnished to a veteran 

3 under subsection (a); and 

4 ‘‘(ii) subject to paragraphs (2) and (3), 

5 provide payment to such critical access hospital 

6 for such services furnished to such veteran in 

7 the same manner and at 100 percent of the 

8 payment rate as would otherwise be made to 

9 such critical access hospital (including any cost10 sharing obligation that would otherwise apply) 

11 if such services were furnished to an individual 

12 entitled to benefits under part A of title XVIII 

13 of the Social Security Act or enrolled under 

14 part B of such Act, as applicable; and 

15 ‘‘(B) not later than 30 days after the Secretary 

16 of Health and Human Services provides such pay17 ment to such critical access hospital, the Secretary 

18 of Veterans Affairs shall reimburse the Secretary of 

19 Health and Human Services an amount equal to— 

20 ‘‘(i) the payment provided to the critical 

21 access hospital pursuant to subparagraph (A) 

22 with respect to such services described in such 

23 subparagraph furnished to such veteran, minus 

24 ‘‘(ii) any portion of such payment for such 

25 services furnished to such veteran for which 


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1 payment would otherwise be made under title 

2 XVIII of such Act (including any cost-sharing 

3 obligation that would otherwise apply) with re4 spect to such veteran, without application of 

5 this subsection, and which would not otherwise 

6 be provided pursuant to this chapter. 

7 ‘‘(2) In the case of care or services furnished to a 

8 veteran by a critical access hospital for which payment 

9 would not be made under title XVIII of the Social Security 

10 Act if such veteran were an individual entitled to benefits 

11 under part A of such title or enrolled under part B, as 

12 applicable, the Secretary of Veterans Affairs and the Sec13 retary of Health and Human Services shall jointly deter14 mine the payment to be made under paragraph (1)(A) to 

15 such critical access hospital for such care or services fur16 nished to such veteran. Subparagraphs (A)(i) and (B) of 

17 paragraph (1) shall apply with respect to such care and 

18 services and any payments made pursuant to the previous 

19 sentence, respectively, in the same manner as such sub20 paragraphs apply to services described in and payments 

21 made under subparagraph (A)(ii) of such paragraph. 

22 ‘‘(3) In the case of services described in paragraph 

23 (1)(B)(ii) furnished to a veteran for which payment would 

24 otherwise be made under title XVIII of the Social Security 

25 Act, any cost-sharing obligation otherwise applicable to 


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1 such veteran under such title with respect to such services 

2 shall apply. 

3 ‘‘(c) ELIGIBILITY.—A veteran shall be eligible for the 

4 hospital care and medical services furnished under sub5 section (a) if the veteran presents to a critical access hos6 pital and provides the critical access hospital with any doc7 ument issued by the Department of Veterans Affairs that 

8 describes the enrollment of the veteran in the health care 

9 system established under section 1705(a) of this title, in10 cluding an identification card described in section 5706(f) 

11 of this title or a Veterans Choice Card described in section 

12 101(f) of the Veterans Access, Choice, and Accountability 

13 Act of 2014 (38 U.S.C. 1701 note). 

14 ‘‘(d) CARE PROVIDED.—The hospital care and med15 ical services furnished to a veteran under subsection (a) 

16 shall be the care or services the eligible veteran is eligible 

17 to receive under this chapter. 

18 ‘‘(e) MEDICAL RECORDS.—The Secretary of Veterans 

19 Affairs shall provide to a critical access hospital the med20 ical records of a veteran being treated by such hospital 

21 if such hospital requests such records. To the extent prac22 ticable, the Secretary shall provide such records electroni23 cally. 

24 ‘‘(f) COSTS TO VETERANS.—Any copayments or 

25 other charges that the Secretary may collect from a vetVerDate Sep 11 2014 00:03 Nov 25, 2015 Jkt 059200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4103.IH H4103

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1 eran or third party pursuant to this chapter for hospital 

2 care or medical services furnished to a veteran at a non3 Department facility shall apply to care or services fur4 nished to the veteran under subsection (a). 

5 ‘‘(g) REPORTS.—During the five-year period begin6 ning on the date of the enactment of this section, and from 

7 time to time thereafter, the Secretary of Veterans Affairs, 

8 in consultation with the Secretary of Health and Human 

9 Services, shall submit to the Committees on Veterans’ Af10 fairs and Energy and Commerce of the House of Rep11 resentatives and the Committees on Veteran’s Affairs and 

12 Health, Education, Labor, and Pensions of the Senate an 

13 annual report on the hospital care and medical services 

14 furnished under subsection (a). Each such report shall ex15 plain how furnishing such care and services under sub16 section (a) affects the following: 

17 ‘‘(1) The resources of the Department of Vet18 erans Affairs. 

19 ‘‘(2) The costs incurred by veterans to receive 

20 such care and services. 

21 ‘‘(3) The amount of time a veteran must wait 

22 to receive hospital care and services. 

23 ‘‘(h) CRITICAL ACCESS HOSPITAL DEFINED.—In 

24 this section, the term ‘critical access hospital’ means a 

25 hospital designated or certified as a critical access hospital 


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1 pursuant to section 1820 of the Social Security Act (42 

2 U.S.C. 1395i–4).’’. 

3 (2) CLERICAL AMENDMENT.—The table of sec4 tions at the beginning of such chapter is amended 

5 by inserting after the item relating to section 1703 

6 the following new item: 

‘‘1703A. Care at critical access hospitals.’’. 

7 (b) MEDICARE CONDITION OF PARTICIPATION.—Sec8 tion 1820(e) of the Social Security Act (42 U.S.C. 1395i– 

9 4(e)) is amended— 

10 (1) in paragraph (2), by striking at the end 

11 ‘‘and’’; 

12 (2) by redesignating paragraph (3) as para13 graph (4); and 

14 (3) by inserting after paragraph (2) the fol15 lowing new paragraph: 

16 ‘‘(3) agrees to furnish items and services to vet17 erans in accordance with the agreement entered into 

18 between the Secretary and the Secretary of Veterans 

19 Affairs under section 1703A of title 38, United 

20 States Code; and’’. 

Æ 


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