```

[House Report 115-65]
[From the U.S. Government Publishing Office]

115th Congress   }                                     {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                     {        115-65

======================================================================

 
 TO ELIMINATE THE SUNSET OF THE VETERANS CHOICE PROGRAM, AND FOR OTHER 
                                PURPOSES

                                _______
                                

 March 29, 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

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 369]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 369) to eliminate the sunset of the Veterans 
Choice Program, and for other purposes, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     3
Hearings.........................................................     5
Subcommittee Consideration.......................................     5
Committee Consideration..........................................     5
Committee Votes..................................................     6
Committee Oversight Findings.....................................     6
Statement of General Performance Goals and Objectives............     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Earmarks and Tax and Tariff Benefits.............................     6
Committee Cost Estimate..........................................     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     8
Applicability to Legislative Branch..............................     8
Statement on Duplication of Federal Programs.....................     8
Disclosure of Directed Rulemaking................................     8
Section-by-Section Analysis of the Legislation...................     9
Changes in Existing Law Made by the Bill as Reported.............     9

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. ELIMINATION OF SUNSET OF THE VETERANS CHOICE PROGRAM.

  Section 101(p)(2) of the Veterans Access, Choice, and Accountability 
Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is amended by 
striking all that follows ``section 802'' and inserting a period.

SEC. 2. ELIMINATION OF REQUIREMENT TO ACT AS SECONDARY PAYER FOR CARE 
                    RELATING TO NON-SERVICE-CONNECTED DISABILITIES AND 
                    RECOVERY OF COSTS FOR CERTAIN CARE UNDER CHOICE 
                    PROGRAM.

  (a) In General.--Section 101(e) of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113-146; 38 U.S.C. 1701 note) is 
amended--
          (1) in the subsection heading, by striking ``Other Health-
        Care Plan'' and inserting ``Responsibility for Costs of Certain 
        Care'';
          (2) in paragraph (1), in the paragraph heading, by striking 
        ``to secretary'' and inserting ``on health-care plans'';
          (3) by striking paragraphs (2) and (3);
          (4) by redesignating paragraph (4) as paragraph (2); and
          (5) by adding at the end the following new paragraph:
          ``(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.''.
  (b) Conforming Amendment.--Paragraph (1) of such section is amended 
by striking ``paragraph (4)'' and inserting ``paragraph (2)''.

SEC. 3. AUTHORITY TO DISCLOSE CERTAIN MEDICAL RECORDS OF VETERANS WHO 
                    RECEIVE NON-DEPARTMENT OF VETERANS AFFAIRS HEALTH 
                    CARE.

  Section 7332(b)(2) of title 38, United States Code, is amended by 
adding at the end the following new subparagraph:
          ``(H)(i) To a non-Department entity (including private 
        entities and other Federal agencies) that provides hospital 
        care or medical services to veterans.
          ``(ii) An entity to which a record is disclosed under this 
        subparagraph may not redisclose or use such record for a 
        purpose other than that for which the disclosure was made.''.

                          Purpose and Summary

    H.R. 369 was introduced by Representative David P. Roe of 
Tennessee, the Chairman of the Committee on Veterans' Affairs, 
on January 9, 2017. H.R. 369, as amended, would: (1) remove the 
three-year sunset date for the Veterans Choice program; (2) 
make the Department of Veterans Affairs (VA) the primary payer 
for the Choice program; and (3) authorize VA to share medical 
record information with a public or private health care 
provider in order to provide care or treatment to a shared 
patient.

                  Background and Need for Legislation

Section 1. Elimination of sunset of the Veterans Choice Program

    VA has been collaborating with medical providers in the 
community to provide timely, quality care to veteran patients 
since 1945. There are a variety of statutory authorities and 
programs that the Veterans Health Administration (VHA)--which 
operates and oversees the VA health care system--uses to refer 
veterans to community providers. The most recent community care 
program is the Choice program (hereinafter referred to as 
``Choice'').
    Choice was established by section 101 of the Veterans 
Access, Choice, and Accountability Act of 2014 (Public Law 113-
146) (the Act). Choice expanded the availability of community 
care to veteran patients by setting specific triggers that 
would require VA to give veterans the option of receiving care 
in the community rather than in a VA medical facility. In 
general, veterans are eligible to receive care through Choice 
if they are unable to secure an appointment at a VA medical 
facility within 30 days or if they reside more than 40 miles 
from the nearest VA medical facility. More than 1.2 million 
veterans have used Choice since its creation to receive needed 
care and, in fiscal year (FY) 2016, 23 percent of all of VA 
community care appointments resulted from the Choice program.
    To fund Choice, section 802 of the Act created--and 
deposited $10 billion into--the Veterans Choice Fund and 
stipulated that Choice will sunset either when the money in the 
Choice fund is fully expended or three years after enactment of 
the Act. Since the law was enacted on August 7, 2014, three 
years after enactment of the Act would be August 7, 2017. At 
the time of the Act's passage, Congress expected that the money 
in the Veterans Choice Fund would be fully expended within 
three years. However, VA currently expects to have anywhere 
from $800 million to $1.2 billion left in the Veterans Choice 
Fund on August 7, 2017. Absent legislation to remove the 
current sunset date, Choice would end on August 7, 2017, and 
any funds remaining in the Veterans Choice Fund must then be 
returned to the Treasury.
    The expiration of Choice this year could have a negative 
impact on access to care for veteran patients. VA's non-Choice 
community care account is not sufficiently resourced to absorb 
the additional demand for care resulting from Choice. 
Furthermore, during a Committee hearing on March 7, 2017, 
Secretary Shulkin testified that, ``[the] looming expiration 
[of Choice] is a cause for concern among veterans, providers, 
and VA staff . . . [as] . . . [w]ithout Congressional action, 
veterans will have to face longer wait times for care.''\1\ The 
Secretary went on to claim that, if Choice is not extended past 
the current sunset date, it would be ``a disaster for American 
veterans.''\2\ VA has already started halting referrals to 
Choice in anticipation of the program's expiration. Services 
that typically require months-long episodes of care, such as 
maternity and oncology care, are already experiencing 
significant impacts as they are likely to outlast the current 
sunset date. However, a ``large number of veterans'' are not 
going to be able to access Choice care ``towards to end of 
April to May [2017],'' should the program not be extended, per 
the Secretary's testimony in early March.\3\
---------------------------------------------------------------------------
    \1\March, 8, 2017; Committee on Veterans' Affairs, U.S. House of 
Representatives, ``Shaping the Future: Consolidating and Improving VA 
Community Care,'' https://veterans.house.gov/hearings/shaping-future-
consolidating-and-improving-va-community-care. 
    \2\Ibid.
    \3\Ibid.
---------------------------------------------------------------------------
    To that end, Section 101 of the bill would remove the 
current August 7, 2017, sunset date for the Choice program, 
which would allow the program to continue operating until all 
of the money remaining in the Veterans Choice Fund is fully 
expended. The Committee recognizes that Choice, in its current 
form, is flawed and in need of improvement to ensure its 
optimal functioning for veterans, VA, community providers, and 
taxpayers alike. The Committee is strongly committed to the 
expeditious development of legislation to improve VA community 
care, in general, and Choice, in particular. However, the 
Committee also recognizes that veterans could be unduly harmed 
by the expiration of Choice on the current sunset date. 
Enactment of Section 101 of the bill would ensure that, as 
Congress moves forward with efforts to improve the provision of 
care in the community to veteran patients, veterans can 
continue to access needed care from Choice and continue to 
benefit from the full amount of money Congress appropriated 
into the Veterans Choice Fund for this intended purpose.

Section 2. Elimination of requirement to act as secondary payer for 
        care relating to non-service connected disabilities and 
        recovery of costs for certain care under Choice Program

    Section 101(e) of the Act stipulates that VA is secondarily 
responsible for costs associated with non-service connected 
care provided pursuant to Choice. In other words, VA is a 
secondary payer for non-service connected care provided under 
Choice. This is different from standard protocol for VA's non-
Choice community care programs wherein VA is the primary payer 
for both service-connected and non-service-connected care and 
collects reasonable charges from a veteran's third party 
insurer--where applicable--for non-service connected care. VA 
claims that the requirement for VA to be the secondary payer 
for Choice has created significant confusion for veterans and 
community providers and that making VA the primary payer under 
Choice, consistent with VA's other care in the community 
programs, would result in timelier and more consistent payments 
to community providers.\4\
---------------------------------------------------------------------------
    \4\January 30, 2017, VA Office the Inspector General report 15-
04673-333, ``Review of the Implementation of the Veterans Choice 
Program,'' https://www.va.gov/oig/pubs/VAOIG-15-04673-333.pdf. 
---------------------------------------------------------------------------
    Section 2 of the bill would eliminate the requirement for 
VA to act as the secondary payer for non-service connected care 
provided under Choice. While the Committee has continued 
concerns regarding VA's ability to efficiently and fully 
collect reimbursements from third parties, the Committee 
understands that the requirement for VA to be a secondary payer 
for non-service connected care has created unforeseen 
challenges that have impeded Choice care in certain instances. 
As such, the Committee is supportive of removing the secondary 
payer requirement to bring Choice fully in line with VA's other 
care in the community programs and to make Choice care more 
efficient.

Section 3. Authority to disclose certain medical records of veterans 
        who receive non-Department of Veterans Affairs health care

    Since FY 2014, VA community care appointments have 
increased by 61 percent overall and by 41 percent as a 
percentage of total VA appointments.\5\ In FY 2016 alone, 25.5 
million appointments--or 30 percent of all VA appointments--
occurred in the community rather than in VA medical 
facilities.\6\ Given the dramatic increase in VA community care 
demand in recent years and the need to ensure that the care 
veterans receive in the community is coordinated and of the 
highest quality, the Committee believes that it is critically 
important for VA and community providers to be able to share 
pertinent medical record information about the veteran patients 
they are jointly treating.
---------------------------------------------------------------------------
    \5\January 11, 2017, MyVA Advisory Committee Meeting, Georgetown 
University, Washington, D.C.
    \6\Ibid.
---------------------------------------------------------------------------
    Accordingly, Section 3 of the bill would authorize VA to 
share medical record information with a public or private 
health care provider in order to provide care or treatment to a 
shared patient but prohibit any subsequent re-disclosure of 
medical record information for a purpose other than that for 
which the original disclosure was made.The Committee believes 
this would improve the provision of care to veteran patients 
from both VA providers and community providers while also 
ensuring that personal patient information is safeguarded from 
inappropriate disclosure.

                                Hearings

    There were no Subcommittee hearings held on H.R. 369.
    On March 7, 2017, the full Committee held an oversight and 
legislative hearing that included a discussion of H.R. 369. The 
following witnesses testified:
          The Honorable John McCain of Arizona, U.S. Senate; 
        the Honorable David J. Shulkin M.D., Secretary of the 
        U.S. Department of Veterans Affairs, who was 
        accompanied by Baligh Yehia M.D., the Deputy Under 
        Secretary for Health for Community Care for the 
        Veterans Health Administration of the U.S. Department 
        of Veterans Affairs; The Honorable Michael J. Missal, 
        Inspector General of the U.S. Department of Veterans 
        Affairs; and Randy Williamson, Health Care Director for 
        the U.S. Government Accountability Office.
    Statements for the record were submitted by:
          The American Legion, the Disabled American Veterans, 
        the Paralyzed Veterans of America, the Veterans of 
        Foreign Wars of the United States, and TriWest 
        Healthcare Alliance.

                       Subcommittee Consideration

    There was no Subcommittee markup of H.R. 369.

                        Committee Consideration

    On March 8, 2017, the full Committee met in open markup 
session, a quorum being present, and ordered H.R. 369, as 
amended, favorably reported to the House of Representatives by 
voice vote. During consideration of the bill, the following 
amendment was considered and agreed to by voice vote:
          An Amendment to H.R. 369 offered by Representative 
        Tim Walz of Minnesota, the Ranking Member of the 
        Committee on Veterans' Affairs.

                            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. 369, as 
amended, reported to the House. A motion by Representative Tim 
Walz of Minnesota, the Ranking Member of the Committee on 
Veterans' Affairs, to report H.R. 369, 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 extend and improve the Choice 
program.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 369, 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

    The Committee adopts as its own the cost estimate on H.R. 
369, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 369, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 20, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 369, a bill to 
eliminate the sunset of the Veterans Choice Program, and for 
other purposes.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                             Mark P. Hadley
                                        (For Keith Hall, Director).
    Enclosure.

H.R. 369--A bill to eliminate the sunset of the Veterans Choice 
        Program, and for other purposes

    The Veterans Choice Program (VCP), enacted on August 7, 
2014, provided $10 billion to the Department of Veterans 
Affairs (VA) to pay for certain veterans to receive health care 
from participating providers in the private sector through the 
earlier of August 7, 2017, or the date when funds are 
exhausted. H.R. 369 would eliminate the sunset date of August 
7, 2017, and allow VA to operate VCP until the $10 billion in 
funding is exhausted.
    The bill also would require VA to act as the primary payer 
rather than a secondary payer for care provided under VCP. 
Currently, VA acts as primary payer only for those veterans who 
are receiving care for service-connected conditions. Under this 
provision, CBO expects that VA would cover more of the health 
care costs for veterans being treated for conditions that are 
not related to military service.
    Through the end of fiscal year 2016, VCP spending totaled 
roughly $6.6 billion for health care appointments, Hepatitis C 
drugs, and other community care. In the January 2017 baseline, 
CBO estimates that VA would obligate all but $200 million of 
the remaining funds for VCP by August 7, 2017. Enacting H.R. 
369 would allow VA to obligate and spend the $200 million that 
would otherwise be unavailable after August 7, 2017; such 
spending is classified as direct spending. (Since we prepared 
our current baseline, VA has released new information that 
indicates that as much as $1 billion of the funding for VCP 
could remain unobligated by August 7, 2017; to the extent that 
unobligated funds are higher than our baseline estimate, direct 
spending under this bill would also be higher.)
    Because CBO estimates that enacting H.R. 369 would increase 
direct spending by $200 million over the 2017-2027 period, pay-
as-you-go procedures apply. Enacting H.R. 369 would not affect 
revenues.

           CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 369 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON VETERANS' AFFAIRS ON MARCH 8, 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                    By fiscal year, in millions of dollars--
                                                      --------------------------------------------------------------------------------------------------
                                                        2017   2018   2019   2020   2021   2022   2023   2024   2025   2026   2027  2017-2022  2017-2027
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               NET INCREASE IN THE DEFICIT
 
Statutory Pay-As-You-Go Impact.......................      0    200      0      0      0      0      0      0      0      0      0       200        200
--------------------------------------------------------------------------------------------------------------------------------------------------------

    CBO estimates that enacting H.R. 369 would not increase net 
direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2028.
    H.R. 369 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impost no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was approved by H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 369, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      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. 
369, as amended.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 369, 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. 369, 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 clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 369, 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. 369, as amended, contains no 
directed rulemaking that would require the Secretary to 
prescribe regulations.

             Section-by-Section Analysis of the Legislation

Section 1. Elimination of sunset of the Veterans Choice Program

    Section 1 of the bill would amend section 101(p)(2) of the 
Veterans Access, Choice, and Accountability Act of 2014 (Public 
Law 113-146) by striking ``section 802'' and inserting a 
period.

Section 2. Elimination of requirement to act as secondary payer for 
        care relating to non-service connected disabilities and 
        recovery of costs for certain care under Choice Program

    Section 2(a) of the bill would amend section 101(e) of the 
Veterans Access, Choice, and Accountability Act of 2014:
          (1) in the subsection heading, by striking ``Other 
        Health-Care Plan'' and inserting ``Responsibility for 
        Costs of Certain Care'';
          (2) in paragraph (1) in the paragraph heading, by 
        striking ``to secretary'' and inserting ``on health-
        care plans'';
          (3) by striking paragraphs (2) and (3);
          (4) by redesignating paragraph (4) as paragraph (2); 
        and
          (5) by adding at the end a new paragraph entitled, 
        ``(3) Recovery of costs for certain care''. This new 
        paragraph would stipulate that in any case in which an 
        eligible veteran is furnished hospital care or medical 
        services under this Section for a non-service connected 
        disability or for a condition in which recovery is 
        authorized or with respect to which the United States 
        is deemed to be a third party beneficiary under the 
        Federal Medical Care Recovery Act (Public Law 87-693), 
        that the Secretary shall recover or collect from a 
        third party 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 and that the 
        amounts collected by the Secretary under paragraph (A) 
        are required to be deposited in the Medical Community 
        Care account to remain available until expended.
    Section 2(b) of the bill would provide a conforming 
amendment to paragraph (1) of section 101(e) of the Veterans 
Access, Choice, and Accountability Act of 2014, particularly by 
striking ``paragraph (4)'' and inserting, ``paragraph (2)''.

Section 3. Authority to disclose certain medical records of veterans 
        who receive non-Department of Veterans Affairs health care

    Section 3 of the bill would amend section 7332(b)(2) of 
title 38, U.S.C., by adding a new paragraph (H).
    Section 7332(b)(2)(H) would authorize VA to disclose 
medical record information to a non-Department entity 
(including private entities and other Federal agencies) that 
provide hospital care or medical services to veterans and 
stipulate that such an entity may not redisclose or use the 
medical record information for a purpose other than that for 
which the disclosure was made.

         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, existing law in which no change is 
proposed is shown in roman):

         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 italics, 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.
  (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)  [Other Health-Care Plan] Responsibility for Costs of 
Certain Care.--
          (1) Submittal of information [to secretary] 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 (4)] 
        paragraph (2) under which the eligible veteran is 
        covered.
          [(2) Disclosure of information to non-department 
        entity.--Notwithstanding section 5701 of title 38, 
        United States Code, for purposes of furnishing hospital 
        care or medical services to an eligible veteran under 
        this section, the Secretary shall disclose to the 
        entity specified in paragraph (1)(B) of subsection (a) 
        with which the Secretary has entered into an agreement 
        described in such subsection--
                  [(A) whether the eligible veteran is covered 
                under a health-care plan described in paragraph 
                (4); and
                  [(B) whether the hospital care or medical 
                services sought by the eligible veteran is for 
                a medical condition that is related to a non-
                service-connected disability described in 
                paragraph (3)(C).
          [(3) Care for which the department is secondarily 
        responsible.--
                  [(A) In general.--If an eligible veteran is 
                covered under a health-care plan described in 
                paragraph (4) and receives hospital care or 
                medical services for a non-service-connected 
                disability described in subparagraph (C), such 
                health-care plan shall be primarily responsible 
                for paying for such care or services, to the 
                extent such care or services is covered by such 
                health-care plan, and the Secretary shall be 
                secondarily responsible for paying for such 
                care or services in accordance with 
                subparagraph (B)(ii).
                  [(B) Responsibility for costs of care.--In a 
                case in which the Secretary is secondarily 
                responsible for paying for hospital care or 
                medical services as described in subparagraph 
                (A)--
                          [(i) the health care provider that 
                        furnishes such care or services 
                        pursuant to an agreement described in 
                        subsection (a) shall be responsible for 
                        seeking reimbursement for the cost of 
                        such care or services from the health-
                        care plan described in paragraph (4) 
                        under which the eligible veteran is 
                        covered; and
                          [(ii) the Secretary shall be 
                        responsible for promptly paying only 
                        the amount that is not covered by such 
                        health-care plan, except that such 
                        responsibility for payment may not 
                        exceed the rate determined for such 
                        care or services pursuant to subsection 
                        (d)(2).
                  [(C) Non-service-connected disability 
                described.--A non-service-connected disability 
                described in this subsection is a non-service-
                connected disability (as defined in section 101 
                of title 38, United States Code)--
                          [(i) that is incurred incident to a 
                        veteran's employment and that is 
                        covered under a workers' compensation 
                        law or plan that provides for payment 
                        for the cost of health care and 
                        services provided to the veteran by 
                        reason of the disability;
                          [(ii) that is incurred as the result 
                        of a motor vehicle accident to which 
                        applies a State law that requires the 
                        owners or operators of motor vehicles 
                        registered in that State to have in 
                        force automobile accident reparations 
                        insurance;
                          [(iii) that is incurred as the result 
                        of a crime of personal violence that 
                        occurred in a State, or a political 
                        subdivision of a State, in which a 
                        person injured as the result of such a 
                        crime is entitled to receive health 
                        care and services at such State's or 
                        subdivision's expense for personal 
                        injuries suffered as the result of such 
                        crime;
                          [(iv) that is incurred by a veteran--
                                  [(I) who does not have a 
                                service-connected disability; 
                                and
                                  [(II) who is entitled to care 
                                (or payment of the expenses of 
                                care) under a health-care plan; 
                                or
                          [(v) for which care and services are 
                        furnished under this section to a 
                        veteran who--
                                  [(I) has a service-connected 
                                disability; and
                                  [(II) is entitled to care (or 
                                payment of the expenses of 
                                care) under a health-care 
                                plan.]
          [(4)] (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[, or the date that is 3 
        years after the date of the enactment of this Act, 
        whichever occurs first.].
          (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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TITLE 38, UNITED STATES CODE

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PART V--BOARDS, ADMINISTRATIONS, AND SERVICES

           *       *       *       *       *       *       *

CHAPTER 73--VETERANS HEALTH ADMINISTRATION - ORGANIZATION AND FUNCTIONS

           *       *       *       *       *       *       *

SUBCHAPTER III--PROTECTION OF PATIENT RIGHTS

           *       *       *       *       *       *       *

Sec. 7332. Confidentiality of certain medical records

  (a)(1) Records of the identity, diagnosis, prognosis, or 
treatment of any patient or subject which are maintained in 
connection with the performance of any program or activity 
(including education, training, treatment, rehabilitation, or 
research) relating to drug abuse, alcoholism or alcohol abuse, 
infection with the human immunodeficiency virus, or sickle cell 
anemia which is carried out by or for the Department under this 
title shall, except as provided in subsections (e) and (f), be 
confidential, and (section 5701 of this title to the contrary 
notwithstanding) such records may be disclosed only for the 
purposes and under the circumstances expressly authorized under 
subsection (b).
  (2) Paragraph (1) prohibits the disclosure to any person or 
entity other than the patient or subject concerned of the fact 
that a special written consent is required in order for such 
records to be disclosed.
  (b)(1) The content of any record referred to in subsection 
(a) may be disclosed by the Secretary in accordance with the 
prior written consent of the patient or subject with respect to 
whom such record is maintained, but only to such extent, under 
such circumstances, and for such purposes as may be allowed in 
regulations prescribed by the Secretary.
  (2) Whether or not any patient or subject, with respect to 
whom any given record referred to in subsection (a) is 
maintained, gives written consent, the content of such record 
may be disclosed by the Secretary as follows:
          (A) To medical personnel to the extent necessary to 
        meet a bona fide medical emergency.
          (B) To qualified personnel for the purpose of 
        conducting scientific research, management audits, 
        financial audits, or program evaluation, but such 
        personnel may not identify, directly or indirectly, any 
        individual patient or subject in any report of such 
        research, audit, or evaluation, or otherwise disclose 
        patient or subject identities in any manner.
          (C)(i) In the case of any record which is maintained 
        in connection with the performance of any program or 
        activity relating to infection with the human 
        immunodeficiency virus, to a Federal, State, or local 
        public-health authority charged under Federal or State 
        law with the protection of the public health, and to 
        which Federal or State law requires disclosure of such 
        record, if a qualified representative of such authority 
        has made a written request that such record be provided 
        as required pursuant to such law for a purpose 
        authorized by such law.
          (ii) A person to whom a record is disclosed under 
        this paragraph may not redisclose or use such record 
        for a purpose other than that for which the disclosure 
        was made.
          (D) If authorized by an appropriate order of a court 
        of competent jurisdiction granted after application 
        showing good cause therefor. In assessing good cause 
        the court shall weigh the public interest and the need 
        for disclosure against the injury to the patient or 
        subject, to the physician-patient relationship, and to 
        the treatment services. Upon the granting of such 
        order, the court, in determining the extent to which 
        any disclosure of all or any part of any record is 
        necessary, shall impose appropriate safeguards against 
        unauthorized disclosure.
          (E) To an entity described in paragraph (1)(B) of 
        section 5701(k) of this title, but only to the extent 
        authorized by such section.
          (F)(i) To a representative of a patient who lacks 
        decision-making capacity, when a practitioner deems the 
        content of the given record necessary for that 
        representative to make an informed decision regarding 
        the patient's treatment.
          (ii) In this subparagraph, the term 
        ``representative'' means an individual, organization, 
        or other body authorized under section 7331 of this 
        title and its implementing regulations to give informed 
        consent on behalf of a patient who lacks decision-
        making capacity.
          (G) To a State controlled substance monitoring 
        program, including a program approved by the Secretary 
        of Health and Human Services under section 399O of the 
        Public Health Service Act (42 U.S.C. 280g-3), to the 
        extent necessary to prevent misuse and diversion of 
        prescription medicines.
          (H)(i) To a non-Department entity (including private 
        entities and other Federal agencies) that provides 
        hospital care or medical services to veterans.
          (ii) An entity to which a record is disclosed under 
        this subparagraph may not redisclose or use such record 
        for a purpose other than that for which the disclosure 
        was made.
  (3) In the event that the patient or subject who is the 
subject of any record referred to in subsection (a) is 
deceased, the content of any such record may be disclosed by 
the Secretary only upon the prior written request of the next 
of kin, executor, administrator, or other personal 
representative of such patient or subject and only if the 
Secretary determines that such disclosure is necessary for such 
survivor to obtain benefits to which such survivor may be 
entitled, including the pursuit of legal action, but then only 
to the extent, under such circumstances, and for such purposes 
as may be allowed in regulations prescribed pursuant to section 
7334 of this title.
  (c) Except as authorized by a court order granted under 
subsection (b)(2)(D), no record referred to in subsection (a) 
may be used to initiate or substantiate any criminal charges 
against, or to conduct any investigation of, a patient or 
subject.
  (d) The prohibitions of this section shall continue to apply 
to records concerning any person who has been a patient or 
subject, irrespective of whether or when such person ceases to 
be a patient.
  (e) The prohibitions of this section shall not prevent any 
interchange of records--
          (1) within and among those components of the 
        Department furnishing health care to veterans, or 
        determining eligibility for benefits under this title; 
        or
          (2) between such components furnishing health care to 
        veterans and the Armed Forces.
  (f)(1) Notwithstanding subsection (a) but subject to 
paragraph (2), a physician or a professional counselor may 
disclose information or records indicating that a patient or 
subject is infected with the human immunodeficiency virus if 
the disclosure is made to (A) the spouse of the patient or 
subject, or (B) to an individual whom the patient or subject 
has, during the process of professional counseling or of 
testing to determine whether the patient or subject is infected 
with such virus, identified as being a sexual partner of such 
patient or subject.
  (2)(A) A disclosure under paragraph (1) may be made only if 
the physician or counselor, after making reasonable efforts to 
counsel and encourage the patient or subject to provide the 
information to the spouse or sexual partner, reasonably 
believes that the patient or subject will not provide the 
information to the spouse or sexual partner and that the 
disclosure is necessary to protect the health of the spouse or 
sexual partner.
  (B) A disclosure under such paragraph may be made by a 
physician or counselor other than the physician or counselor 
referred to in subparagraph (A) if such physician or counselor 
is unavailable by reason of absence or termination of 
employment to make the disclosure.
  (g) Any person who violates any provision of this section or 
any regulation issued pursuant to this section shall be fined, 
in the case of a first offense, up to the maximum amount 
provided under section 5701(f) of this title for a first 
offense under that section and, in the case of a subsequent 
offense, up to the maximum amount provided under section 
5701(f) of this title for a subsequent offense under that 
section.

           *       *       *       *       *       *       *

                             MINORITY VIEWS

    We interpret section 1 of H.R. 369 as amended, as granting 
the VA Secretary the authority to spend only the remaining 
funds in the Veterans Choice Fund under section 802 of the 
Veterans Access, Choice, and Accountability Act of 2014 (Choice 
Act).\1\ Section 1 does not grant authorization to appropriate 
funds in section 802 of the Choice Act, or grant the VA 
Secretary the authority to obligate funds for the Veterans 
Choice Program under section 101 of the Choice Act from other 
existing medical care accounts including the separate account 
for medical community care established under section 4003 of 
the Surface Transportation and Veterans Health Care Choice 
Improvement Act of 2015.\2\
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    \1\P.L. 113-146
    \2\P.L. 114-41
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    We are pleased that our amendment to H.R. 369 was 
considered and adopted in full Committee markup. This showing 
of bipartisanship demonstrates that when we work together as a 
Committee, we can champion meaningful policies that help our 
veterans.

                                   Timothy J. Walz.
                                   Mark Takano.
                                   Scott H. Peters.
                                   Julia Brownley.
                                   Kathleen M. Rice.
                                   Ann M. Kuster.
                                   J. Luis Correa.
                                   Elizabeth H. Esty.

                                  [all]
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