I 

114TH CONGRESS 

2D SESSION H. R. 4591 

To amend title 38, United States Code, to authorize the Secretary of Veterans 

Affairs to enter into agreements with certain health care providers to 

furnish hospital care, medical services, and extended care to veterans. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 23, 2016 

Mr. MILLER of Florida introduced the following bill; which was referred to 

the Committee on Veterans’ Affairs 

A BILL 

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

Secretary of Veterans Affairs to enter into agreements 

with certain health care providers to furnish hospital 

care, medical services, and extended care to veterans. 

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 ‘‘Department of Vet5 erans Affairs Purchased Health Care Streamlining and 

6 Modernization Act’’. 


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1 SEC. 2. AGREEMENTS. 

2 (a) IN GENERAL.—Subchapter I of chapter 17 of title 

3 38, United States Code, is amended by inserting after sec4 tion 1703 the following new section: 

5 ‘‘§ 1703A. Veterans Care Agreements with certain 

6 health care providers 

7 ‘‘(a) VETERANS CARE AGREEMENTS.—(1) In addi8 tion to furnishing hospital care, medical services, or ex9 tended care under this chapter at facilities of the Depart10 ment or under contracts or sharing agreements entered 

11 into pursuant to provisions of law other than this section, 

12 the Secretary may furnish such care and services to eligi13 ble veterans through the use of agreements entered into 

14 under this section by the Secretary with eligible providers. 

15 ‘‘(2) The Secretary may enter into Veterans Care 

16 Agreements under this section with eligible providers to 

17 furnish hospital care, medical services, and extended care 

18 to veterans whom the Secretary determines that fur19 nishing such care and services at facilities of the Depart20 ment or under contracts or sharing agreements under pro21 visions of law other than this section is impracticable or 

22 inadvisable because of the medical condition of the vet23 eran, the travel involved, or the nature of the care or serv24 ices required, or a combination of such factors. 

25 ‘‘(b) VETERAN ELIGIBILITY.—Eligibility of a veteran 

26 for care and services under this section shall be deterVerDate Sep 11 2014 02:18 Feb 24, 2016 Jkt 059200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4591.IH H4591

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1 mined as if such care or services were furnished in a facil2 ity of the Department, and provisions of this title applica3 ble to veterans receiving such care and services in a facility 

4 of the Department shall apply to veterans receiving care 

5 and services under this section. 

6 ‘‘(c) PROVIDER ELIGIBILITY.—Subject to the certifi7 cation process pursuant to subsection (d)(1), a provider 

8 of hospital care, medical services, or extended care is eligi9 ble to enter into a Veterans Care Agreement under this 

10 section if the Secretary determines that the provider meets 

11 each of the following criteria: 

12 ‘‘(1) The gross annual revenue of the provider 

13 in the year preceding the year in which the provider 

14 enters into the Veterans Care Agreement does not 

15 exceed $11,000,000 (as adjusted in a manner simi16 lar to amounts adjusted pursuant to section 5312 of 

17 this title). 

18 ‘‘(2) The provider does not otherwise provide 

19 such care or services to patients pursuant to a con20 tract entered into with a department or agency of 

21 the Federal Government. 

22 ‘‘(3) The provider is— 

23 ‘‘(A) a provider of services that has en24 rolled and entered into a provider agreement 


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1 under section 1866(a) of the Social Security 

2 Act (42 U.S.C. 1395cc(a)); 

3 ‘‘(B) a physician or supplier that has en4 rolled and entered into a participation agree5 ment under section 1842(h) of such Act (42 

6 U.S.C. 1395u(h)); 

7 ‘‘(C) a provider of items and services re8 ceiving payment under a State plan under title 

9 XIX of such Act (42 U.S.C. 1396 et seq.) or 

10 a waiver of such a plan; 

11 ‘‘(D) an Aging and Disability Resource 

12 Center, an area agency on aging, or a State 

13 agency (as defined in section 102 of the Older 

14 Americans Act of 1965 (42 U.S.C. 3002)); or 

15 ‘‘(E) a center for independent living (as 

16 defined in section 702 of the Rehabilitation Act 

17 of 1973 (29 U.S.C. 796a)). 

18 ‘‘(4) Any additional criteria determined appro19 priate by the Secretary. 

20 ‘‘(d) PROVIDER CERTIFICATION.—(1) The Secretary 

21 shall establish a process for the certification of eligible 

22 providers to enter into Veterans Care Agreements under 

23 this section that shall, at a minimum, set forth the fol24 lowing: 


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1 ‘‘(A) Procedures for the submission of applica2 tions for certification and deadlines for actions taken 

3 by the Secretary with respect to such applications. 

4 ‘‘(B) Standards and procedures for the ap5 proval and denial of certifications and the revocation 

6 of certifications. 

7 ‘‘(C) Procedures for assessing eligible providers 

8 based on the risk of fraud, waste, and abuse of such 

9 providers similar to the level of screening under sec10 tion 1866(j)(2)(B) of the Social Security Act (42 

11 U.S.C. 1395(j)(2)(B)) and the standards set forth 

12 under section 9.104 of title 48, Code of Federal 

13 Regulations, or any successor regulation. 

14 ‘‘(D) Requirement for denial or revocation of 

15 certification if the Secretary determines that the 

16 otherwise eligible provider is— 

17 ‘‘(i) excluded from participation in a Fed18 eral health care program (as defined in section 

19 1128B(f) of the Social Security Act (42 U.S.C. 

20 1320a–7b(f))) under section 1128 or 1128A of 

21 the Social Security Act (42 U.S.C. 1320a–7 

22 and 1320a–7a); or 

23 ‘‘(ii) identified as an excluded source on 

24 the list maintained in the System for Award 

25 Management, or any successor system. 


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1 ‘‘(E) Procedures by which a provider whose cer2 tification is denied or revoked under the procedures 

3 established under this subsection will be identified as 

4 an excluded source on the list maintained in the Sys5 tem for Award Management, or successor system, if 

6 the Secretary determines that such exclusion is ap7 propriate. 

8 ‘‘(2) To the extent practicable, the Secretary shall es9 tablish the procedures under paragraph (1) in a manner 

10 that takes into account any certification process adminis11 tered by another department or agency of the Federal 

12 Government that an eligible provider has completed by 

13 reason of being a provider described in any of subpara14 graphs (A) through (E) of subsection (c)(3). 

15 ‘‘(e) TERMS OF AGREEMENTS.—The Secretary shall 

16 ensure that each Veterans Care Agreement include provi17 sions requiring the eligible provider to do the following: 

18 ‘‘(1) To accept payment for care and services 

19 furnished under this section at rates established by 

20 the Secretary for purposes of this section, which 

21 shall be, to the extent practicable— 

22 ‘‘(A) the rates paid by the United States 

23 for such care to providers of services and sup24 pliers under the Medicare program under title 


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1 XVIII of the Social Security Act (42 U.S.C. 

2 1395 et seq.); 

3 ‘‘(B) the rates paid by the United States 

4 pursuant to the Alaska Fee Schedule of the De5 partment of Veterans Affairs; 

6 ‘‘(C) the rates paid by the United States 

7 pursuant to an All-Payer Model Agreement 

8 under the Social Security Act; or 

9 ‘‘(D) the rates paid by the United States 

10 in a highly rural area pursuant to section 

11 101(d)(2)(B)(ii)(I) of the Veterans Access, 

12 Choice, and Accountability Act of 2014 (38 

13 U.S.C. 1701 note). 

14 ‘‘(2) To accept payment under paragraph (1) as 

15 payment in full for care and services furnished 

16 under this section and to not seek any payment for 

17 such care and services from the recipient of such 

18 care. 

19 ‘‘(3) To furnish under this section only the care 

20 and services authorized by the Department under 

21 this section unless the eligible provider receives prior 

22 written consent from the Department to furnish care 

23 and services outside the scope of such authorization. 

24 ‘‘(4) To bill the Department for care and serv25 ices furnished under this section in accordance with 


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1 a methodology established by the Secretary for pur2 poses of this section. 

3 ‘‘(5) Not to seek to recover or collect from a 

4 health-plan contract or third party (as those terms 

5 are defined in section 1729 of this title) for any care 

6 or services for which payment is made by the De7 partment under this section. 

8 ‘‘(6) To provide medical records for veterans 

9 furnished care and services under this section to the 

10 Department in a timeframe and format specified by 

11 the Secretary for purposes of this section, except the 

12 Secretary may not require that any payment by the 

13 Secretary to the eligible provider be contingent on 

14 such provision of medical records. 

15 ‘‘(7) To meet other such terms and conditions, 

16 including quality of care assurance standards, as the 

17 Secretary may specify for purposes of this section. 

18 ‘‘(f) EXCLUSION OF CERTAIN FEDERAL CON19 TRACTING PROVISIONS.—(1) Notwithstanding any other 

20 provision of law, the Secretary may enter into a Veterans 

21 Care Agreement using procedures other than competitive 

22 procedures. 

23 ‘‘(2)(A) Except as provided in subparagraph (B) and 

24 unless otherwise provided in this section, an eligible pro25 vider that enters into a Veterans Care Agreement under 


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1 this section is not subject to, in the carrying out of the 

2 agreement, any provision of law that providers of services 

3 and suppliers under the original Medicare fee-for-service 

4 program under parts A and B of title XVIII of the Social 

5 Security Act (42 U.S.C. 1395 et seq.) or the Medicaid pro6 gram under title XIX of such Act (42 U.S.C. 1396 et seq.) 

7 are not subject to. 

8 ‘‘(B) In addition to the provisions of laws covered by 

9 subparagraph (A), an eligible provider shall be subject to 

10 the following provisions of law: 

11 ‘‘(i) Any applicable law regarding integrity, eth12 ics, or fraud, or that subject a person to civil or 

13 criminal penalties. 

14 ‘‘(ii) Section 431 of title 18. 

15 ‘‘(iii) Section 1352 of title 31, except for the fil16 ing requirements under subsection (b) of such sec17 tion. 

18 ‘‘(iv) Section 4705 or 4712 of title 41, and any 

19 other applicable law regarding the protection of 

20 whistleblowers. 

21 ‘‘(v) Section 4706(d) of title 41. 

22 ‘‘(vi) Title VII of the Civil Rights Act of 1964 

23 (42 U.S.C. 2000e et seq.) to the same extent as 

24 such title applies with respect to the eligible provider 

25 in providing care or services through an agreement 


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1 or arrangement other than under a Veterans Care 

2 Agreement. 

3 ‘‘(C) An eligible provider that receives a payment 

4 from the Federal Government pursuant to a Veterans 

5 Care Agreement shall not be treated as a Federal con6 tractor or subcontractor by the Office of Federal Contract 

7 Compliance Programs of the Department of Labor based 

8 on the work performed or actions taken by such eligible 

9 provider that resulted in the receipt of such payments. 

10 ‘‘(g) TERMINATION OF VETERANS CARE AGREE11 MENT.—(1) An eligible provider may terminate a Veterans 

12 Care Agreement with the Secretary under this section at 

13 such time and upon such notice to the Secretary as the 

14 Secretary may specify for purposes of this section. 

15 ‘‘(2) The Secretary may terminate a Veterans Care 

16 Agreement with an eligible provider under this section at 

17 such time and upon such notice to the eligible provider 

18 as the Secretary may specify for the purposes of this sec19 tion, if the Secretary— 

20 ‘‘(A) determines that the eligible provider failed 

21 to comply with the provisions of the agreement or 

22 this section or other applicable provision of law; 

23 ‘‘(B) makes a revocation pursuant to subsection 

24 (d)(1)(4); 


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1 ‘‘(C) ascertains that the eligible provider has 

2 been convicted of a felony or other serious offense 

3 under Federal or State law and determines that the 

4 continued participation of the eligible provider would 

5 be detrimental to the best interests of veterans of 

6 the Department; or 

7 ‘‘(D) determines that it is reasonable to termi8 nate the agreement based on the health care needs 

9 of veterans. 

10 ‘‘(h) DURATION; MANDATORY REVIEWS.—(1) Each 

11 Veterans Care Agreement entered into under this section 

12 shall be for a two-year period unless the Secretary extends 

13 the agreement pursuant to paragraph (2)(B). 

14 ‘‘(2)(A) During the 180-day period beginning 540 

15 days after the date on which a Veterans Care Agreement 

16 is entered into or renewed, the Secretary shall review the 

17 agreement to determine whether it is feasible and advis18 able to instead furnish the hospital care, medical services, 

19 or extended care furnished under the agreement at facili20 ties of the Department or through contracts or sharing 

21 agreements entered into under authorities other than this 

22 section. 

23 ‘‘(B) If the Secretary determines under subparagraph 

24 (A) that it is not feasible and advisable to instead furnish 

25 hospital care, medical services, or extended care furnished 


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1 under a Veterans Care Agreement at facilities of the De2 partment or through contracts or sharing agreements en3 tered into under authorities other than this section, the 

4 Secretary— 

5 ‘‘(i) shall prepare a written memorandum of 

6 such determination; and 

7 ‘‘(ii) may renew such agreement. 

8 ‘‘(i) DISPUTES.—(1) The Secretary shall establish 

9 administrative procedures for eligible providers with which 

10 the Secretary has entered into a Veterans Care Agreement 

11 to present any dispute arising under or related to the 

12 agreement. 

13 ‘‘(2) Before using any dispute resolution mechanism 

14 under chapter 71 of title 41 with respect to a dispute aris15 ing under a Veterans Care Agreement under this section, 

16 an eligible provider must first exhaust the administrative 

17 procedures established by the Secretary under paragraph 

18 (1). 

19 ‘‘(j) ANNUAL REPORTS.—Not later than October 1 

20 of the year following the fiscal year in which the Secretary 

21 first enters into a Veterans Care Agreement, and each 

22 year thereafter, the Secretary shall submit to the appro23 priate congressional committees an annual report that in24 cludes— 


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1 ‘‘(1) a list of all Veterans Care Agreements en2 tered into as of the date of the report; and 

3 ‘‘(2) summaries of each determination made by 

4 the Secretary under subsection (h)(2) during the fis5 cal year covered by the report. 

6 ‘‘(k) QUALITY OF CARE.—In carrying out this sec7 tion, the Secretary shall use the quality of care standards 

8 set forth or used by the Centers for Medicare & Medicaid 

9 Services. 

10 ‘‘(l) DELEGATION.—The Secretary may delegate the 

11 authority to enter into or terminate a Veterans Care 

12 Agreement, or to make a determination described in sub13 section (h)(2), at a level not below the Assistant Deputy 

14 Under Secretary for Health for Community Care. 

15 ‘‘(m) SUNSET.—The Secretary may not enter into or 

16 renew a Veterans Care Agreement under this section after 

17 the date that is five years after the enactment of this Act. 

18 ‘‘(n) DEFINITIONS.—In this section: 

19 ‘‘(1) The term ‘appropriate congressional com20 mittees’ means— 

21 ‘‘(A) the Committees on Veterans’ Affairs 

22 of the House of Representatives and the Sen23 ate; and 

24 ‘‘(B) the Committees on Appropriations of 

25 the House of Representatives and the Senate. 


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1 ‘‘(2) The term ‘eligible provider’ means a pro2 vider of hospital care, medical services, or extended 

3 care that the Secretary determines is eligible to 

4 enter into Veterans Care Agreements under sub5 section (c). 

6 ‘‘(3) The term ‘Veterans Care Agreement’ 

7 means an agreement entered into by the Secretary 

8 with an eligible provider under subsection (a)(1).’’. 

9 (b) CLERICAL AMENDMENT.—The table of sections 

10 at the beginning of chapter 17 of such title is amended 

11 by inserting after the item related to section 1703 the fol12 lowing new item: 

‘‘1703A. Veterans Care Agreements with certain health care providers.’’. 

13 (c) REGULATIONS.—Not later than one year after the 

14 date of the enactment of this Act, the Secretary of Vet15 erans Affairs shall prescribe interim final regulations to 

16 implement section 1703A of title 38, United States Code, 

17 as added by subsection (a), and publish such regulations 

18 in the Federal Register. 

Æ 


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