II 

115TH CONGRESS 

1ST SESSION S. 1279 

To amend title 38, United States Code, to furnish health care from the 

Department of Veterans Affairs through the use of non-Department 

health care providers, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

MAY 25, 2017 

Mr. CRAPO introduced the following bill; which was read twice and referred 

to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to furnish health 

care from the Department of Veterans Affairs through 

the use of non-Department health care providers, and 

for other purposes. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Veterans Health Administration Reform Act of 2017’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Establishment of Care in the Community Program. 


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Sec. 3. Authorization of provider agreements under Care in the Community 

Program. 

Sec. 4. Expansion of reimbursement of veterans for emergency treatment and 

urgent care. 

Sec. 5. Memorandum of understanding between Department of Veterans Affairs and Centers for Medicare & Medicaid Services. 

Sec. 6. Education program on health care options from Department of Veterans Affairs. 

Sec. 7. Training program for administration of Non-Department of Veterans 

Affairs health care. 

Sec. 8. Analysis of electronic health record of Department of Veterans Affairs. 

Sec. 9. Reports assessing effectiveness of certain positions and offices of Department of Veterans Affairs. 

Sec. 10. Sense of Congress regarding reforms at the Veterans Health Administration. 

1 SEC. 2. ESTABLISHMENT OF CARE IN THE COMMUNITY 

2 PROGRAM. 

3 (a) ESTABLISHMENT OF PROGRAM.— 

4 (1) IN GENERAL.—Section 1703 of title 38, 

5 United States Code, is amended to read as follows: 

6 ‘‘§ 1703. Care in the Community Program 

7 ‘‘(a) IN GENERAL.—(1) The Secretary may furnish 

8 care and services described in subsection (c) to eligible vet9 erans described in subsection (b) from non-Department 

10 health care providers through the use of Veterans Care 

11 Agreements under section 1703A of this title, arrange12 ments under subsection (d), or under any other law ad13 ministered by the Secretary. The furnishing of care and 

14 services under this section may be referred to as the ‘Care 

15 in the Community Program’. 

16 ‘‘(2) For purposes of this section, care or services 

17 ‘furnished by’ the Secretary means that the Secretary auVerDate Sep 11 2014 05:17 Jun 07, 2017 Jkt 069200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279

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1 thorizes the care or services and pays for the care or serv2 ices. 

3 ‘‘(3) An eligible veteran may elect to decline to receive 

4 care or services furnished under this section and instead 

5 receive such care or services at a medical facility of the 

6 Department. 

7 ‘‘(b) ELIGIBLE VETERANS.—(1) A veteran is an eligi8 ble veteran for purposes of this section if the veteran is 

9 enrolled in the system of annual patient enrollment estab10 lished and operated under section 1705 of this title and 

11 one or more of the following conditions apply: 

12 ‘‘(A) The Secretary determines that it is in the 

13 clinical best interest of the veteran to access care or 

14 services outside of the Department. 

15 ‘‘(B) The veteran would experience an undue 

16 burden if the veteran seeks care or services from the 

17 Department. 

18 ‘‘(C) It is not economical for the Department to 

19 provide the veteran the care or services that the vet20 eran needs. 

21 ‘‘(2) A determination by the Secretary under para22 graph (1)(A) shall include an assessment of factors relat23 ing to the medical or clinical condition of the veteran and 

24 the timeliness of the Department in providing the care or 

25 services required by the veteran. 


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1 ‘‘(3) For purposes of paragraph (1)(B), an undue 

2 burden— 

3 ‘‘(A) means— 

4 ‘‘(i) an excessive driving distance, geo5 graphical challenges, or environmental factors 

6 impede the access of the veteran to care or 

7 services from the Department; or 

8 ‘‘(ii) the care or services sought by the vet9 eran are not provided by a medical facility of 

10 the Department that is reasonably accessible to 

11 the veteran; and 

12 ‘‘(B) may include other circumstances as deter13 mined by the Secretary upon assessing— 

14 ‘‘(i) the nature or complexity of the care or 

15 services that the veteran requires; 

16 ‘‘(ii) the frequency with which the veteran 

17 requires such care or services; and 

18 ‘‘(iii) the need for an attendant to provide 

19 required aid or physical assistance to the vet20 eran for the veteran to travel to a medical facil21 ity of the Department. 

22 ‘‘(c) CARE AND SERVICES DESCRIBED.—Care and 

23 services described in this subsection are the following: 

24 ‘‘(1) Hospital care. 

25 ‘‘(2) Medical services. 


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1 ‘‘(3) Diagnostic care. 

2 ‘‘(4) With respect to veterans described in sec3 tion 1712(a)(1)(F) of this title, outpatient dental 

4 services and treatment and related dental appli5 ances. 

6 ‘‘(5) Such other care or services as determined 

7 by the Secretary. 

8 ‘‘(d) ARRANGEMENTS.—(1) The Secretary may pro9 vide care and services under this section through arrange10 ments described in paragraph (2). 

11 ‘‘(2) Arrangements described in this paragraph are 

12 the following: 

13 ‘‘(A) Health care coordination and sharing ac14 tivities with the Department of Defense under sec15 tion 8111 of this title. 

16 ‘‘(B) Arrangements under section 8153 of this 

17 title. 

18 ‘‘(C) Arrangements between the Secretary and 

19 the Director of the Indian Health Service. 

20 ‘‘(D) Agreements under section 1745 of this 

21 title. 

22 ‘‘(E) Agreements with Federally-qualified 

23 health centers (as defined in section 1905(l)(2)(B) 

24 of the Social Security Act (42 U.S.C. 

25 1396d(l)(2)(B))). 


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1 ‘‘(3) Nothing in this section may be construed to 

2 modify the way the Department, other Federal agencies, 

3 and States determine responsibility for payment under ar4 rangements described in paragraph (2). 

5 ‘‘(e) PROHIBITION ON COLLECTION OF PAYMENT.— 

6 A health care provider that provides care or services under 

7 this section shall agree not to recover or collect payment 

8 from— 

9 ‘‘(1) an eligible veteran in connection with care 

10 or services furnished under this section; or 

11 ‘‘(2) a health-plan contract or other third party 

12 on behalf of the eligible veteran in connection with 

13 such care or services. 

14 ‘‘(f) ELECTRONIC WAITING LIST FOR CARE AT DE15 PARTMENT FACILITIES.—(1) If an eligible veteran seeks 

16 care or services under this section, the Secretary shall pro17 vide the veteran an opportunity to be included on an elec18 tronic waiting list maintained by the Department for an 

19 appointment for care or services described in subsection 

20 (c) at a medical facility of the Department. 

21 ‘‘(2) The electronic waiting list maintained under 

22 paragraph (1) shall allow access by each eligible veteran 

23 via www.myhealth.va.gov or any successor website (or 

24 other digital channel) for the following purposes: 


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1 ‘‘(A) To determine the place of such eligible 

2 veteran on the waiting list. 

3 ‘‘(B) To determine the average length of time 

4 an individual spends on the waiting list, 

5 disaggregated by medical facility of the Department 

6 and type of care or service needed, for purposes of 

7 allowing such eligible veteran to make an informed 

8 election to receive care or services under this section 

9 or at a medical facility of the Department. 

10 ‘‘(g) INFORMATION ON AVAILABILITY OF CARE.— 

11 The Secretary shall provide information to a veteran about 

12 the availability of care and services under this section in 

13 the following circumstances: 

14 ‘‘(1) When the veteran enrolls in the system of 

15 annual patient enrollment established and operated 

16 under section 1705 of this title. 

17 ‘‘(2) When the veteran attempts to schedule an 

18 appointment for the receipt of care or services de19 scribed in subsection (c) from the Department but 

20 is unable to schedule an appointment within the 

21 wait-time goals of the Veterans Health Administra22 tion for the furnishing of such care or services. 

23 ‘‘(3) When the veteran becomes eligible for care 

24 or services under this section under subparagraph 

25 (A), (B), or (C) of subsection (b)(1). 


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1 ‘‘(h) FOLLOW-UP CARE.—In carrying out this sec2 tion, the Secretary shall ensure that, at the election of an 

3 eligible veteran who receives care or services from a health 

4 care provider in an episode of care under this section, the 

5 veteran receives such care or services from such health 

6 care provider through the completion of the episode of care 

7 (but for a period not exceeding one year), including all 

8 specialty and ancillary services deemed necessary as part 

9 of the treatment recommended in the course of such care 

10 or services. 

11 ‘‘(i) COST SHARING.—(1) The Secretary shall require 

12 an eligible veteran to pay a copayment for the receipt of 

13 care or services under this section only if such eligible vet14 eran would be required to pay a copayment for the receipt 

15 of such care or services at a medical facility of the Depart16 ment or from a health care provider of the Department. 

17 ‘‘(2) The amount of a copayment charged under 

18 paragraph (1) may not exceed the amount of the copay19 ment that would be payable by such eligible veteran for 

20 the receipt of such care or services at a medical facility 

21 of the Department or from a health care provider of the 

22 Department. 

23 ‘‘(j) ADMINISTRATION OF PROGRAM.—(1) The Non24 VA Care Coordination Program of the Department, work25 ing jointly with the Chief Business Office of the DepartVerDate Sep 11 2014 05:17 Jun 07, 2017 Jkt 069200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279

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1 ment, shall administer the Care in the Community Pro2 gram under this section. 

3 ‘‘(2) Administration of the Care in the Community 

4 Program shall include the following: 

5 ‘‘(A) Ensuring that an eligible veteran receives 

6 an appointment for care or services under this sec7 tion within— 

8 ‘‘(i) the wait-time goals of the Veterans 

9 Health Administration; or 

10 ‘‘(ii) the period that a health care provider 

11 of the veteran at the Department determines 

12 the care or services are needed. 

13 ‘‘(B) Ensuring that the Secretary, including 

14 any contractors of the Secretary, pay health care 

15 providers on time. 

16 ‘‘(C) Ensuring that medical information of an 

17 eligible veteran who receives care or services under 

18 this section is sent to the health care provider of the 

19 veteran at the Department. 

20 ‘‘(D) Ensuring that the Secretary has informa21 tion regarding any other health insurance of an eli22 gible veteran. 

23 ‘‘(3) The Secretary shall ensure that the Non-VA 

24 Care Coordination Program of the Department and the 

25 Chief Business Office of the Department are working toVerDate Sep 11 2014 05:17 Jun 07, 2017 Jkt 069200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279

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1 gether effectively and efficiently throughout the process of 

2 furnishing care under this section. 

3 ‘‘(4) The Secretary shall notify the Committee on 

4 Veterans’ Affairs of the Senate and the Committee on Vet5 erans’ Affairs of the House of Representatives if any func6 tions under this subsection require alteration or realign7 ment. 

8 ‘‘(k) PAYMENT OF CLAIMS.—(1) The Secretary shall 

9 ensure that all payments of claims under this section com10 ply with chapter 39 of title 31 (commonly referred to as 

11 the ‘Prompt Payment Act’) and the requirements of this 

12 subsection. If there is a conflict between the requirements 

13 of the Prompt Payment Act and the requirements of this 

14 subsection, the Secretary shall comply with the require15 ments of this subsection. 

16 ‘‘(2)(A) Payment by the Secretary of claims under 

17 this section shall be issued, mailed, or otherwise trans18 mitted with respect to not less than 95 percent of all such 

19 claims within 30 days after the date on which the claim 

20 is received, if— 

21 ‘‘(i) the claim is a clean claim; and 

22 ‘‘(ii) the claim is not one for which payment is 

23 made on a periodic interim payment basis. 

24 ‘‘(B) In this paragraph, the term ‘clean claim’ means 

25 a claim that has no defect or impropriety (including any 


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1 lack of any required substantiating documentation) or par2 ticular circumstance requiring special treatment that pre3 vents timely payment from being made on the claim under 

4 this section. 

5 ‘‘(3)(A) The Secretary is the primary payer for all 

6 care or services furnished under this section. 

7 ‘‘(B) The Secretary may recover or collect reasonable 

8 charges for care or services furnished under this section 

9 from a third party pursuant to section 1729 of this title 

10 or any other provision of law that would permit the Sec11 retary to recover or collect the cost of care furnished at 

12 a facility of the Department or under the laws adminis13 tered by the Secretary. 

14 ‘‘(l) ONLINE PORTAL.—The Secretary shall establish 

15 an online portal that health care providers participating 

16 in the Care in the Community Program may use as fol17 lows: 

18 ‘‘(1) To submit medical information with re19 spect to eligible veterans furnished care or services 

20 under this section. 

21 ‘‘(2) To file claims for payment for care or 

22 services furnished under this section. 

23 ‘‘(3) To monitor the status of payment of 

24 claims under this section, including whether or not 

25 the claim was approved or rejected. 


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1 ‘‘(4) To determine whether the Secretary re2 quires additional information before processing the 

3 claim. 

4 ‘‘(m) ANNUAL REPORT ON CONTRACT CARE.—(1) 

5 Not later than April 1 each year, the Secretary shall sub6 mit to the Committee on Veterans’ Affairs of the Senate 

7 and the Committee on Veterans’ Affairs of the House of 

8 Representatives a report on health care contracted for 

9 under the laws administered by the Secretary, including 

10 under the Care in the Community Program. 

11 ‘‘(2) Each report submitted under paragraph (1) 

12 shall— 

13 ‘‘(A) describe the use by the Secretary of Vet14 erans Care Agreements under section 1703A of this 

15 title, arrangements under subsection (e), and other 

16 contracts or agreements for health care under this 

17 section or any other law administered by the Sec18 retary; 

19 ‘‘(B) state the number of such agreements, ar20 rangements, or contracts entered into and the costs 

21 of such agreements, arrangements, or contracts, 

22 disaggregated by medical center of the Department; 

23 and 

24 ‘‘(C) include an assessment by the Central Of25 fice of the Veterans Health Administration of the efVerDate Sep 11 2014 05:17 Jun 07, 2017 Jkt 069200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279

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1 forts of such office to coordinate such agreements, 

2 arrangements, or contracts. 

3 ‘‘(n) RULE OF CONSTRUCTION.—Nothing in this sec4 tion or section 1703A of this title shall be construed to 

5 prevent the Secretary from entering into regional or na6 tional contracts to provide prescription medication, dialy7 sis treatment, prosthetics, and such other care or services 

8 under this section as the Secretary considers appro9 priate.’’. 

10 (2) CLERICAL AMENDMENT.—The table of sec11 tions at the beginning of chapter 17 of such title is 

12 amended by striking the item related to section 1703 

13 and inserting the following new item: 

‘‘1703. Care in the Community Program.’’. 

14 (3) REPORT ON DEVELOPMENT AND IMPLE15 MENTATION OF ONLINE PORTAL.— 

16 (A) IN GENERAL.—Not later than Decem17 ber 31, 2017, the Under Secretary for Health 

18 of the Department of Veterans Affairs shall 

19 submit to Congress a report on the development 

20 and implementation by the Department of Vet21 erans Affairs of the online portal established 

22 under subsection (m) of section 1703 of title 

23 38, United States Code, as added by paragraph 

24 (1), for the processing of claims by health care 


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1 providers under the Care in the Community 

2 Program under such section. 

3 (B) ELEMENTS.—The report required by 

4 subparagraph (A) shall include the following: 

5 (i) A detailed schedule for developing 

6 and implementing the online portal de7 scribed in subparagraph (A). 

8 (ii) An assessment of whether the on9 line portal includes the following elements: 

10 (I) Automatic adjudication of 

11 claims. 

12 (II) Automated entry of author13 izations for care or services. 

14 (III) A mechanism by which 

15 health care providers can electroni16 cally submit medical records, includ17 ing health care providers that a vet18 eran may have seen without author19 ization from the Department. 

20 (IV) A web-based portal for 

21 health care providers to check the sta22 tus of their claims. 

23 (iii) Estimated costs for developing 

24 and implementing each aspect of the online 

25 portal. 


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1 (iv) Performance goals, measures, and 

2 interim milestones that the Under Sec3 retary for Health will use to evaluate 

4 progress, hold staff accountable for achiev5 ing desired results, and report to stake6 holders on the impact of the online portal 

7 in modernizing the claims processing sys8 tem of the Department. 

9 (b) CONFORMING AMENDMENTS.— 

10 (1) DENTAL CARE.—Section 1712(a)(3) of title 

11 38, United States Code, is amended, in paragraph 

12 (3), by striking ‘‘under clause (1), (2), or (5) of sec13 tion 1703(a) of this title’’ and inserting ‘‘under sec14 tion 1703 of this title’’. 

15 (2) READJUSTMENT COUNSELING.—Section 

16 1712A(e)(1) of such title is amended by striking 

17 ‘‘sections 1703(a)(2) and 1710(a)(1)(B) of this 

18 title’’ and inserting ‘‘sections 1703 and 

19 1710(a)(1)(B) of this title’’. 

20 (3) CONFORMING REPEAL OF SUPERSEDED AU21 THORITY.— 

22 (A) IN GENERAL.—Section 101 of the Vet23 erans Access, Choice, and Accountability Act of 

24 2014 (Public Law 113–146; 38 U.S.C. 1701 

25 note) is repealed. 


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1 (B) CONFORMING AMENDMENT.—Section 

2 208 of such Act is amended— 

3 (i) in paragraph (1), by striking ‘‘hos4 pital care and medical services under sec5 tion 101’’ and inserting ‘‘care and services 

6 under section 1703 of title 38, United 

7 States Code’’; and 

8 (ii) in paragraph (2), by striking 

9 ‘‘hospital care and medical services’’ and 

10 inserting ‘‘care and services’’. 

11 (c) REPEAL OF AUTHORITY TO CONTRACT FOR

12 SCARCE MEDICAL SPECIALISTS.— 

13 (1) IN GENERAL.—Section 7409 of title 38, 

14 United States Code, is repealed. 

15 (2) CLERICAL AMENDMENT.—The table of sec16 tions at the beginning of chapter 74 of such title is 

17 amended by striking the item relating to section 

18 7409. 

19 SEC. 3. AUTHORIZATION OF PROVIDER AGREEMENTS 

20 UNDER CARE IN THE COMMUNITY PROGRAM. 

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

22 38, United States Code, is amended by inserting after sec23 tion 1703 the following new section: 


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1 ‘‘§ 1703A. Care in the Community Program: provider 

2 agreements 

3 ‘‘(a) AGREEMENTS TO FURNISH CARE.—The Sec4 retary may furnish care and services under the Care in 

5 the Community Program under section 1703 of this title 

6 by entering into agreements under this section with eligi7 ble providers that are certified under subsection (c). 

8 ‘‘(b) ELIGIBLE PROVIDERS.—For purposes of this 

9 section, an eligible provider is one of the following: 

10 ‘‘(1) A provider of services that has enrolled 

11 and entered into a provider agreement under section 

12 1866(a) of the Social Security Act (42 U.S.C. 

13 1395cc(a)). 

14 ‘‘(2) A physician or supplier that has enrolled 

15 and entered into a participation agreement under 

16 section 1842(h) of such Act (42 U.S.C. 1395u(h)). 

17 ‘‘(3) A provider of items and services receiving 

18 payment under a State plan under title XIX of such 

19 Act (42 U.S.C. 1396 et seq.) or a waiver of such a 

20 plan. 

21 ‘‘(4) A provider that is— 

22 ‘‘(A) an Aging and Disability Resource 

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

24 agency (as defined in section 102 of the Older 

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


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1 ‘‘(B) a center for independent living (as 

2 defined in section 702 of the Rehabilitation Act 

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

4 ‘‘(5) Such other health care providers as the 

5 Secretary considers appropriate for purposes of this 

6 section. 

7 ‘‘(c) CERTIFICATION OF ELIGIBLE PROVIDERS.—The 

8 Secretary shall establish a process for the certification of 

9 eligible providers under this section. 

10 ‘‘(d) RATES FOR CARE AND SERVICES.—(1) Except 

11 as otherwise provided in this subsection, an eligible pro12 vider that enters into an agreement under this section to 

13 provide care or services under section 1703 of this title 

14 shall agree to accept as payment in full for such care or 

15 services an amount equal to the rate paid by the United 

16 States to a provider of services (as defined in section 

17 1861(u) of the Social Security Act (42 U.S.C. 1395x(u))) 

18 or a supplier (as defined in section 1861(d) of such Act 

19 (42 U.S.C. 1395x(d))) under the Medicare program under 

20 title XVIII of the Social Security Act (42 U.S.C. 1395 

21 et seq.) for the same care or services. 

22 ‘‘(2)(A) A higher rate than the rate paid by the 

23 United States as described in paragraph (1) may be nego24 tiated with respect to the furnishing of care or services 

25 to a veteran who resides in a highly rural area. 


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1 ‘‘(B) In this paragraph, the term ‘highly rural area’ 

2 means an area located in a county that has fewer than 

3 seven individuals residing in that county per square mile. 

4 ‘‘(3) With respect to furnishing care or services under 

5 this subsection in Alaska, the Alaska Fee Schedule of the 

6 Department of Veterans Affairs shall be followed, except 

7 for when another payment agreement, including a contract 

8 or provider agreement, is in place. 

9 ‘‘(4) With respect to furnishing care or services under 

10 this subsection in a State with an All-Payer Model Agree11 ment under section 1814(b)(3) of the Social Security Act 

12 (42 U.S.C. 1395f(b)(3)) that became effective on January 

13 1, 2014, the Medicare payment rates under subparagraph 

14 (A) shall be calculated based on the payment rates under 

15 such agreement. 

16 ‘‘(5) With respect to furnishing care or services under 

17 this subsection for which there is not a rate paid under 

18 the Medicare program as described in paragraph (1), such 

19 as dental care, obstetrics and gynecology, and other serv20 ices, the rate paid for such care or services shall be deter21 mined by the Secretary. 

22 ‘‘(6) In determining rates and making payments 

23 under this subsection, the Secretary may conduct pilot 

24 programs on alternative payment systems similar to those 

25 used under the Medicare program, including the MeritVerDate Sep 11 2014 05:17 Jun 07, 2017 Jkt 069200 PO 00000 Frm 00019 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279

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1 based Incentive Payment System under section 1848(q) 

2 of the Social Security Act (42 U.S.C. 1395w–4(q)) and 

3 alternative payment models (as defined in section 

4 1833(z)(3)(C) of the Social Security Act (42 U.S.C. 

5 1395l(z)(3)(C))). 

6 ‘‘(7) If a higher rate than the rate specified in para7 graph (1) is determined under this subsection, the Sec8 retary shall notify the Centers for Medicare & Medicaid 

9 Services regarding such higher rate. 

10 ‘‘(e) TREATMENT OF CERTAIN LAWS.—(1) An agree11 ment under this section may be entered into without re12 gard to any contracting law that would require the Sec13 retary to use competitive procedures in selecting the party 

14 with which to enter into the agreement. 

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

16 unless otherwise provided in this section or regulations 

17 prescribed pursuant to this section, an eligible provider 

18 that enters into an agreement under this section is not 

19 subject to, in the carrying out of the agreement, any con20 tracting law that an eligible provider described in sub21 section (b)(1), (b)(2), or (b)(3) is not subject to under the 

22 original Medicare fee-for-service program under parts A 

23 and B of title XVIII of the Social Security Act (42 U.S.C. 

24 1395 et seq.) or the Medicaid program under title XIX 

25 of such Act (42 U.S.C. 1396 et seq.). 


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1 ‘‘(B) The exclusion under subparagraph (A) does not 

2 apply to laws regarding integrity, ethics, fraud, or that 

3 subject a person to civil or criminal penalties. 

4 ‘‘(3) Title VII of the Civil Rights Act of 1964 (42 

5 U.S.C. 2000e et seq.) shall apply with respect to an eligi6 ble provider that enters into an agreement under this sec7 tion to the same extent as such title applies with respect 

8 to the eligible provider in providing care or services 

9 through an agreement or arrangement other than under 

10 this section.’’. 

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

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

13 by inserting after the item related to section 1703 the fol14 lowing new item: 

‘‘1703A. Care in the Community Program: provider agreements.’’. 

15 SEC. 4. EXPANSION OF REIMBURSEMENT OF VETERANS 

16 FOR EMERGENCY TREATMENT AND URGENT 

17 CARE. 

18 (a) IN GENERAL.—Section 1725 of title 38, United 

19 States Code, is amended to read as follows: 

20 ‘‘§ 1725. Reimbursement for emergency treatment 

21 and urgent care 

22 ‘‘(a) IN GENERAL.—(1) Subject to the provisions of 

23 this section, the Secretary shall reimburse a veteran de24 scribed in subsection (b) for the reasonable value of emerVerDate Sep 11 2014 05:17 Jun 07, 2017 Jkt 069200 PO 00000 Frm 00021 Fmt 6652 Sfmt 6201 E:\BILLS\S1279.IS S1279

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1 gency treatment or urgent care furnished the veteran in 

2 a non-Department facility. 

3 ‘‘(2) In any case in which reimbursement of a veteran 

4 is authorized under paragraph (1), the Secretary may, in 

5 lieu of reimbursing the veteran, make payment of the rea6 sonable value of the furnished emergency treatment or ur7 gent care directly— 

8 ‘‘(A) to the hospital or other health care pro9 vider that furnished the treatment or care; or 

10 ‘‘(B) to the person or organization that paid for 

11 such treatment or care on behalf of the veteran. 

12 ‘‘(b) ELIGIBILITY.—A veteran described in this sub13 section is an individual who— 

14 ‘‘(1) is enrolled in the patient enrollment sys15 tem of the Department established and operated 

16 under section 1705 of this title; and 

17 ‘‘(2) has received care under this chapter dur18 ing the 24-month period preceding the furnishing of 

19 the emergency treatment or urgent care for which 

20 reimbursement is sought under this section. 

21 ‘‘(c) EMERGENCY TRANSPORTATION.—Notwith22 standing section 111 of this title, reimbursement of emer23 gency treatment or urgent care under this section shall 

24 include reimbursement for the reasonable value of emer25 gency transportation. 


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1 ‘‘(d) RESPONSIBILITY FOR PAYMENT.—The Sec2 retary shall be primarily responsible for reimbursing or 

3 otherwise paying the reasonable value of emergency treat4 ment or urgent care under this section. 

5 ‘‘(e) LIMITATIONS ON PAYMENT.—(1) The Secretary, 

6 in accordance with regulations prescribed by the Secretary 

7 for purposes of this section, shall— 

8 ‘‘(A) establish the maximum amount payable 

9 under subsection (a); and 

10 ‘‘(B) delineate the circumstances under which 

11 such payments may be made, including such require12 ments on requesting reimbursement as the Secretary 

13 may establish. 

14 ‘‘(2)(A) Payment by the Secretary under this section 

15 on behalf of a veteran to a provider of emergency treat16 ment or urgent care shall, unless rejected and refunded 

17 by the provider within 30 days of receipt— 

18 ‘‘(i) constitute payment in full for the emer19 gency treatment or urgent care provided; and 

20 ‘‘(ii) extinguish any liability on the part of the 

21 veteran for that treatment or care. 

22 ‘‘(B) Neither the absence of a contract or agreement 

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1 ment, or assignment to the contrary shall operate to mod2 ify, limit, or negate the requirements of subparagraph (A). 

3 ‘‘(C) A provider of emergency treatment or urgent 

4 care may not seek to recover from any third party the 

5 cost of emergency treatment or urgent care for which the 

6 provider has received payment from the Secretary under 

7 this section. 

8 ‘‘(f) RECOVERY.—The United States has the right to 

9 recover or collect reasonable charges for emergency treat10 ment or urgent care furnished under this section in ac11 cordance with the provisions of section 1729 of this title. 

12 ‘‘(g) COST SHARING.—(1) The Secretary shall re13 quire a veteran to pay a copayment for the receipt of emer14 gency treatment or urgent care under this section only if 

15 such veteran would be required to pay a copayment for 

16 the receipt of such treatment or care at a medical facility 

17 of the Department or from a health care provider of the 

18 Department. 

19 ‘‘(2) The amount of a copayment charged to a vet20 eran under paragraph (1) may not exceed the amount of 

21 the copayment that would be payable by such veteran for 

22 the receipt of emergency treatment or urgent care at a 

23 medical facility of the Department or from a health care 

24 provider of the Department. 

25 ‘‘(h) DEFINITIONS.—In this section: 


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1 ‘‘(1) The term ‘emergency treatment’ means 

2 medical care or services furnished, in the judgment 

3 of the Secretary— 

4 ‘‘(A) when such care or services are ren5 dered in a medical emergency of such nature 

6 that a prudent layperson reasonably expects 

7 that delay in seeking immediate medical atten8 tion would be hazardous to life or health; and 

9 ‘‘(B) until— 

10 ‘‘(i) such time as the veteran can be 

11 transferred safely to a Department facility 

12 or community care provider authorized by 

13 the Secretary and such facility or provider 

14 is capable of accepting such transfer; or 

15 ‘‘(ii) such time as a Department facil16 ity or community care provider authorized 

17 by the Secretary accepts such transfer if— 

18 ‘‘(I) at the time the veteran could 

19 have been transferred safely to such a 

20 facility or provider, no such facility or 

21 provider agreed to accept such trans22 fer; and 

23 ‘‘(II) the non-Department facility 

24 in which such medical care or services 

25 was furnished made and documented 


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1 reasonable attempts to transfer the 

2 veteran to a Department facility or 

3 community care provider. 

4 ‘‘(2) The term ‘health-plan contract’ includes 

5 any of the following: 

6 ‘‘(A) An insurance policy or contract, med7 ical or hospital service agreement, membership 

8 or subscription contract, or similar arrangement 

9 under which health services for individuals are 

10 provided or the expenses of such services are 

11 paid. 

12 ‘‘(B) An insurance program described in 

13 section 1811 of the Social Security Act (42 

14 U.S.C. 1395c) or established by section 1831 of 

15 such Act (42 U.S.C. 1395j). 

16 ‘‘(C) A State plan for medical assistance 

17 approved under title XIX of such Act (42 

18 U.S.C. 1396 et seq.). 

19 ‘‘(D) A workers’ compensation law or plan 

20 described in section 1729(a)(2)(A) of this title. 

21 ‘‘(3) The term ‘third party’ means any of the 

22 following: 

23 ‘‘(A) A Federal entity. 

24 ‘‘(B) A State or political subdivision of a 

25 State. 


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1 ‘‘(C) An employer or an employer’s insur2 ance carrier. 

3 ‘‘(D) An automobile accident reparations 

4 insurance carrier. 

5 ‘‘(E) A person or entity obligated to pro6 vide, or to pay the expenses of, health services 

7 under a health-plan contract. 

8 ‘‘(4) The term ‘urgent care’ shall have the 

9 meaning given that term by the Secretary in regula10 tions prescribed by the Secretary for purposes of 

11 this section.’’. 

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

13 at the beginning of chapter 17 is amended by striking the 

14 item relating to section 1725 and inserting the following 

15 new item: 

‘‘1725. Reimbursement for emergency treatment and urgent care.’’. 

16 (c) REPEAL OF SUPERSEDED AUTHORITY.—Section 

17 1728 is repealed. 

18 (d) CONFORMING AMENDMENTS.— 

19 (1) MEDICAL CARE FOR SURVIVORS AND DE20 PENDENTS.—Section 1781(a)(4) is amended by 

21 striking ‘‘(as defined in section 1725(f) of this 

22 title)’’ and inserting ‘‘(as defined in section 1725(h) 

23 of this title)’’. 

24 (2) HEALTH CARE OF FAMILY MEMBERS OF

25 VETERANS STATIONED AT CAMP LEJEUNE, NORTH


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1 CAROLINA.—Section 1787(b)(3) is amended by strik2 ing ‘‘(as defined in section 1725(f) of this title)’’ and 

3 inserting ‘‘(as defined in section 1725(h) of this 

4 title)’’. 

5 (e) REGULATIONS.—Not later than 270 days after 

6 the date of the enactment of this Act, the Secretary shall 

7 prescribe regulations to carry out the amendments made 

8 by this section. 

9 (f) EFFECTIVE DATE.—The amendments made by 

10 this section shall take effect one year after the date of 

11 the enactment of this Act. 

12 SEC. 5. MEMORANDUM OF UNDERSTANDING BETWEEN DE13 PARTMENT OF VETERANS AFFAIRS AND CEN14 TERS FOR MEDICARE & MEDICAID SERVICES. 

15 (a) SENSE OF CONGRESS.—It is the sense of Con16 gress that the Secretary of Veterans Affairs should ensure 

17 that a veteran who is enrolled in Medicare or Medicaid, 

18 is eligible for care or services under the Care in the Com19 munity Program under section 1703 of title 38, United 

20 States Code, as amended by section 2(a)(1), and seeks 

21 care or services for a non-service-connected disability or 

22 condition, knows that the veteran may use his or her bene23 fits under Medicare or Medicaid before the Secretary au24 thorizes the use of funds of the Department of Veterans 

25 Affairs. 


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1 (b) PURPOSE.—The purpose of this section is to fa2 cilitate coordination and communication between the De3 partment of Veterans Affairs and the Centers for Medi4 care & Medicaid Services for the benefit of veterans in the 

5 receipt of health care. 

6 (c) MEMORANDUM OF UNDERSTANDING.— 

7 (1) IN GENERAL.—The Secretary of Veterans 

8 Affairs and the Administrator of the Centers for 

9 Medicare & Medicaid Services shall enter into a 

10 memorandum of understanding regarding the coordi11 nation of care between the Department of Veterans 

12 Affairs and the Centers for Medicare & Medicaid 

13 Services. 

14 (2) REFERRAL OF PATIENTS.— 

15 (A) IN GENERAL.—The memorandum of 

16 understanding under paragraph (1) shall permit 

17 health care providers of the Department of Vet18 erans Affairs to refer veterans eligible for bene19 fits under Medicare or Medicaid to non-Depart20 ment health care providers in the community to 

21 use the Medicare or Medicaid benefits of such 

22 veterans. 

23 (B) TREATMENT OF REFERRAL.—Referral 

24 of a veteran under subparagraph (A) does not 

25 authorize the Secretary of Veterans Affairs— 


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1 (i) to use funds of the Department of 

2 Veterans Affairs to conduct the referral or 

3 pay for care or services furnished pursuant 

4 to such a referral; or 

5 (ii) to furnish care or services to the 

6 veteran under the Care in the Community 

7 Program under section 1703 of title 38, 

8 United States Code, as amended by section 

9 2(a)(1). 

10 (3) SHARING OF INFORMATION.—As part of the 

11 memorandum of understanding under paragraph 

12 (1), the Secretary and the Administrator shall agree 

13 to share information in connection with the coordi14 nation of care under such memorandum, including 

15 by establishing a mechanism to share patient infor16 mation. 

17 (4) TECHNICAL ASSISTANCE FOR CARE IN THE

18 COMMUNITY PROGRAM.— 

19 (A) IN GENERAL.—As part of the memo20 randum of understanding under paragraph (1), 

21 the Administrator may provide technical assist22 ance to the Secretary regarding the develop23 ment of a program for non-Department health 

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1 munity Program under section 1703 of title 38, 

2 United States Code, as amended by section 

3 2(a)(1). 

4 (B) INTEROPERABILITY AND SAFETY OF

5 INFORMATION.—In providing technical assist6 ance under subparagraph (A), the Adminis7 trator shall provide advice regarding interoper8 ability and methods for safeguarding the secu9 rity of patient information. 

10 (C) USE OF ASSISTANCE.—The Secretary 

11 shall use any technical assistance provided 

12 under subparagraph (A) in the development of 

13 a web-based self-service portal for non-Depart14 ment health care providers to be used under 

15 subsection (l) of section 1703 of title 38, 

16 United States Code, as amended by section 

17 2(a)(1). 

18 (d) EDUCATION PROGRAM.— 

19 (1) IN GENERAL.—The Secretary of Veterans 

20 Affairs and the Administrator of the Centers for 

21 Medicare & Medicaid Services shall jointly develop 

22 and administer an education program to inform vet23 erans how their benefits from the Department of 

24 Veterans Affairs are separate from and interact with 

25 their benefits under Medicare or Medicaid. 


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1 (2) ELEMENTS OF PROGRAM.—The education 

2 program under paragraph (1) shall— 

3 (A) assist veterans in making informed de4 cisions about when to use benefits from the De5 partment and when to use benefits under Medi6 care or Medicaid; 

7 (B) provide information on which services 

8 require referrals from the Department and 

9 which services require no referral; and 

10 (C) explain any financial costs that may be 

11 required to receive care, including copayments 

12 under Medicare or from the Department. 

13 (3) USE OF MEMORANDUM OF UNDER14 STANDING.—The education program under para15 graph (1) may be implemented pursuant to the 

16 memorandum of understanding under subsection (c). 

17 (e) RULE OF CONSTRUCTION.—This section may not 

18 be construed to authorize or require the Secretary of Vet19 erans Affairs to reimburse the Administrator of the Cen20 ters for Medicare & Medicaid Services for health care serv21 ices or for the Administrator to reimburse the Secretary 

22 for such services. 

23 (f) DEFINITIONS.—In this section: 


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1 (1) MEDICAID.—The term ‘‘Medicaid’’ means 

2 the Medicaid program under title XIX of the Social 

3 Security Act (42 U.S.C. 1396 et seq.). 

4 (2) MEDICARE.—The term ‘‘Medicare’’ means 

5 the Medicare program under title XVIII of such Act 

6 (42 U.S.C. 1395 et seq.). 

7 (3) NON-SERVICE-CONNECTED.—The term 

8 ‘‘non-service-connected’’ has the meaning given that 

9 term in section 101 of title 38, United States Code. 

10 SEC. 6. EDUCATION PROGRAM ON HEALTH CARE OPTIONS 

11 FROM DEPARTMENT OF VETERANS AFFAIRS. 

12 (a) IN GENERAL.—The Secretary of Veterans Affairs 

13 shall develop and administer an education program that 

14 teaches veterans about their health care options through 

15 the Department of Veterans Affairs. 

16 (b) ELEMENTS.—The program under subsection (a) 

17 shall— 

18 (1) teach veterans about— 

19 (A) eligibility criteria for care from the De20 partment set forth under section 1710 of title 

21 38, United States Code; 

22 (B) priority groups for enrollment in the 

23 system of annual patient enrollment under sec24 tion 1705(a) of such title; and 


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1 (C) the copayments and other financial ob2 ligations, if any, required of certain individuals 

3 for certain services; 

4 (2) teach veterans about the interaction be5 tween health insurance (including private insurance, 

6 Medicare, Medicaid, the TRICARE program, and 

7 other forms of insurance) and health care from the 

8 Department; and 

9 (3) provide veterans information on what to do 

10 when they have a complaint about health care re11 ceived from the Department (whether about the doc12 tor, the Department, or any other type of com13 plaint). 

14 (c) INCLUSION OF INFORMATION FROM EDUCATION

15 PROGRAM ON MEDICARE AND MEDICAID.—The education 

16 program under this section shall include information from 

17 the education program under section 6(d). 

18 (d) ACCESSIBILITY.—In developing the education 

19 program under this section, the Secretary shall ensure 

20 that materials under such program are accessible to vet21 erans who may not have access to the Internet. 

22 (e) DEFINITIONS.—In this section: 

23 (1) MEDICAID.—The term ‘‘Medicaid’’ means 

24 the Medicaid program under title XIX of the Social 

25 Security Act (42 U.S.C. 1396 et seq.). 


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1 (2) MEDICARE.—The term ‘‘Medicare’’ means 

2 the Medicare program under title XVIII of such Act 

3 (42 U.S.C. 1395 et seq.). 

4 (3) TRICARE PROGRAM.—The term 

5 ‘‘TRICARE program’’ has the meaning given that 

6 term in section 1072 of title 10, United States Code. 

7 SEC. 7. TRAINING PROGRAM FOR ADMINISTRATION OF 

8 NON-DEPARTMENT OF VETERANS AFFAIRS 

9 HEALTH CARE. 

10 (a) IN GENERAL.—The Secretary of Veterans Affairs 

11 shall develop and implement a training program to train 

12 employees and contractors of the Department of Veterans 

13 Affairs on how to administer non-Department health care 

14 programs, including the following: 

15 (1) Reimbursement for non-Department emer16 gency room and urgent care under section 1725 of 

17 title 38, United States Code. 

18 (2) The Care in the Community Program under 

19 section 1703 of such title, as amended by section 

20 2(a)(1). 

21 (b) INCLUSION OF TRAINING ON COOPERATION

22 WITH CENTERS FOR MEDICARE & MEDICAID SERV23 ICES.—The training program under subsection (a) shall 

24 include training on coordinating care between the Depart25 ment and Medicare and Medicaid, including pursuant to 


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1 the memorandum of understanding between the Secretary 

2 of Veterans Affairs and the Administrator of the Centers 

3 for Medicare & Medicaid Services under section 6(a). 

4 (c) DEFINITIONS.—In this section: 

5 (1) MEDICAID.—The term ‘‘Medicaid’’ means 

6 the Medicaid program under title XIX of the Social 

7 Security Act (42 U.S.C. 1396 et seq.). 

8 (2) MEDICARE.—The term ‘‘Medicare’’ means 

9 the Medicare program under title XVIII of such Act 

10 (42 U.S.C. 1395 et seq.). 

11 SEC. 8. ANALYSIS OF ELECTRONIC HEALTH RECORD OF DE12 PARTMENT OF VETERANS AFFAIRS. 

13 (a) IN GENERAL.—The Chief Information Officer of 

14 the Veterans Health Administration, in partnership with 

15 the Chief Information Officer of the Department of Vet16 erans Affairs, shall conduct a comprehensive cost-benefit 

17 analysis among selecting a commercial off-the-shelf elec18 tronic health record, selecting an open source electronic 

19 health record, or continuing the in-house custom develop20 ment of the VistA electronic health record currently in use 

21 by the Veterans Health Administration. 

22 (b) ELEMENTS.—The analysis conducted under sub23 section (a) shall— 

24 (1) take into account the complexities of the 

25 computerized patient record system architecture and 


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1 infrastructure of the VistA electronic health record 

2 and known issues with performance, scalability, ex3 tensibility, interoperability, and security of such 

4 health record; and 

5 (2) address full life-cycle costs, including devel6 opment time (based on recent delivery trends), avail7 ability of development resources, maintenance and li8 censing costs, and infrastructure costs. 

9 (c) REPORT.— 

10 (1) INITIAL REPORT.—Not later than Sep11 tember 30, 2017, the Secretary of Veterans Affairs 

12 shall submit to the Committee on Veterans’ Affairs 

13 of the Senate and the Committee on Veterans’ Af14 fairs of the House of Representatives a report on the 

15 progress of the analysis conducted under subsection 

16 (a). 

17 (2) FINAL REPORT.—Not later than December 

18 31, 2017, the Secretary shall submit to the Com19 mittee on Veterans’ Affairs of the Senate and the 

20 Committee on Veterans’ Affairs of the House of 

21 Representatives the results of the analysis conducted 

22 under subsection (a). 


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1 SEC. 9. REPORTS ASSESSING EFFECTIVENESS OF CERTAIN 

2 POSITIONS AND OFFICES OF DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) REPORT ON CIO OF VETERANS HEALTH ADMIN5 ISTRATION.— 

6 (1) IN GENERAL.—Not later than December 31, 

7 2017, the Secretary of Veterans Affairs shall submit 

8 to the Committee on Veterans’ Affairs of the Senate 

9 and the Committee on Veterans’ Affairs of the 

10 House of Representatives a report assessing whether 

11 the Chief Information Officer of the Veterans Health 

12 Administration serves as an effective advocate for 

13 the information technology needs of the Department 

14 of Veterans Affairs for health care delivery. 

15 (2) ELEMENTS.—The report required by para16 graph (1) shall include a description of the require17 ments for an effective health care management sys18 tem that would advance the mission and goals of the 

19 Veterans Health Administration. 

20 (3) USE OF INFORMATION.—In preparing the 

21 report under paragraph (1), the Secretary shall in22 clude information from the Under Secretary for 

23 Health of the Department of Veterans Affairs and 

24 the Chief Information Officer of the Department of 

25 Veterans Affairs. 


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1 (b) REPORT ON OFFICE OF INFORMATION AND

2 TECHNOLOGY.— 

3 (1) IN GENERAL.—Not later than December 31, 

4 2017, the Secretary of Veterans Affairs shall submit 

5 to the Committee on Veterans’ Affairs of the Senate 

6 and the Committee on Veterans’ Affairs of the 

7 House of Representatives a report assessing whether 

8 the Office of Information and Technology of the De9 partment of Veterans Affairs acts as a service pro10 vider and delivers information technology capabilities 

11 and services that improve health care delivery to vet12 erans. 

13 (2) USE OF SURVEY DATA.—In preparing the 

14 report under paragraph (1), the Secretary shall in15 clude the results of clinician and veteran surveys as16 sessing the quality of and satisfaction with capabili17 ties and services of the Department. 

18 SEC. 10. SENSE OF CONGRESS REGARDING REFORMS AT 

19 THE VETERANS HEALTH ADMINISTRATION. 

20 (a) FINDINGS.—Congress finds that section 201 of 

21 the Veterans Access, Choice, and Accountability Act of 

22 2014 (Public Law 113–146; 38 U.S.C. 1701 note) re23 quired an independent assessment of the hospital care, 

24 medical services, and other health care furnished in med25 ical facilities of the Department of Veterans Affairs. That 


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1 assessment provided valuable insight into needed reforms 

2 at the Veterans Health Administration, particularly with 

3 respect to governance, operations, data and tools, and 

4 leadership. 

5 (b) SENSE OF CONGRESS.— 

6 (1) IN GENERAL.—It is the sense of Congress 

7 that the Secretary of Veterans Affairs should take 

8 every effort to address as many of the reforms de9 scribed in subsection (a) as practicable. 

10 (2) ELEMENTS.—In making reforms described 

11 in subsection (a), it is the sense of Congress that the 

12 Secretary should do the following: 

13 (A) Improve the overall management of the 

14 Veterans Health Administration as follows: 

15 (i) By ensuring that the Administra16 tion provides the decision making rights, 

17 authorities, and responsibilities to the low18 est appropriate level. Such decision making 

19 rights, authorities, and responsibilities 

20 should be articulated by level, organization, 

21 and role, and should be standardized to the 

22 extent possible while allowing local flexi23 bility based on local needs. 

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1 ministration, the Veterans Integrated Serv2 ice Networks, the medical centers of the 

3 Department, the community-based out4 patient clinics of the Department, and 

5 other organizational entities, while 

6 prioritizing providing support to the field. 

7 (iii) By reassessing all of the directed 

8 metrics and policies of the Central Office 

9 of the Administration to ensure those 

10 metrics and policies add sufficient value to 

11 patient outcomes. The Secretary should 

12 eliminate the metrics and policies that do 

13 not add sufficient value to patient out14 comes. 

15 (iv) By reviewing the implementation 

16 of the Patient Aligned Care Team staffing 

17 model of the Department, including by de18 termining areas for improvement, to exam19 ine— 

20 (I) causes of gaps in facility 

21 benchmarks between actual, max22 imum, modeled, and external bench23 marks; and 


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1 (II) impacts on access to quality 

2 of care and appropriateness of per3 formance standards and guidelines. 

4 (B) Improve collaboration between the Of5 fice of Information and Technology of the De6 partment and the Veterans Health Administra7 tion. 

8 (C) Improve resource management and 

9 business processes by— 

10 (i) prioritizing the use of a patient11 centered demand model that forecasts re12 sources needed by geographic location to 

13 improve access and make informed 

14 resourcing decisions; and 

15 (ii) improving coordination across pa16 tient access, clinical administration, and 

17 patient accounting functions by forming an 

18 internal committee of key revenue cycle 

19 and administrative stakeholders, standard20 izing the recovery processes for billing, im21 proving third-party contracts management, 

22 and developing approaches to resolve fre23 quently recurring denials. 

Æ 


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