II 

115TH CONGRESS 

1ST SESSION S. 1611 

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

Affairs to enter into certain agreements with non-Department of Veterans 

Affairs health care providers if the Secretary is not feasibly able to 

provide health care in facilities of the Department or through contracts 

or sharing agreements, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 20, 2017 

Mr. HOEVEN (for himself and Mr. ROUNDS) 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 allow the Secretary of Veterans Affairs to enter into certain agreements with non-Department of Veterans Affairs health 

care providers if the Secretary is not feasibly able to 

provide health care in facilities of the Department or 

through contracts or sharing agreements, 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. 

4 This Act may be cited as the ‘‘Veterans Access to 

5 Long Term Care and Health Services Act’’. 


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1 SEC. 2. PURPOSE. 

2 The purpose of this Act is— 

3 (1) to maintain the access of veterans to high4 quality hospital care, medical services, and extended 

5 care if that care is not available directly from the 

6 Department of Veterans Affairs; 

7 (2) to continue to allow the use by the Depart8 ment of agreements covered by the Federal Acquisi9 tion Regulation and agreements that are not covered 

10 by such regulation, similar to those agreements used 

11 under the original Medicare fee-for-service program 

12 (Medicare Parts A and B), if it is not practicable to 

13 contract for the care needed by veterans through an 

14 agreement covered by such regulation; 

15 (3) to address the fact that individual health 

16 care providers, especially smaller providers in rural 

17 areas, may not be willing to accept veterans as pa18 tients when doing so would require the significant 

19 time and administrative requirements in connection 

20 with entering into agreements with the Department 

21 that are covered by such regulation; 

22 (4) to address the deficiencies in current law re23 garding agreements entered into by the Department 

24 that have raised legal issues; and 

25 (5) to ensure that agreements that are not cov26 ered by such regulation include robust terms and 


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1 conditions that address the quality of health care for 

2 veterans, oversight of the provision of such health 

3 care, and protections for taxpayers. 

4 SEC. 3. AUTHORIZATION OF AGREEMENTS BETWEEN THE 

5 DEPARTMENT OF VETERANS AFFAIRS AND 

6 NON-DEPARTMENT HEALTH CARE PRO7 VIDERS. 

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

9 38, United States Code, is amended by adding after sec10 tion 1703 the following new section: 

11 ‘‘§ 1703A. Veterans Care Agreements with certain 

12 health care providers 

13 ‘‘(a) AGREEMENTS TO FURNISH CARE.—(1) If the 

14 Secretary is not feasibly able to furnish hospital care, med15 ical services, or extended care under this chapter at facili16 ties of the Department or under contracts or sharing 

17 agreements entered into under authorities other than this 

18 section, the Secretary may furnish such care and services 

19 by entering into agreements under this section with eligi20 ble providers that are certified under subsection (c). An 

21 agreement entered into under this section may be referred 

22 to as a ‘Veterans Care Agreement’. 

23 ‘‘(2) The Secretary is not feasibly able to furnish care 

24 or services as described in paragraph (1) if the Secretary 

25 determines that the medical condition of the veteran, the 


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1 travel involved, the nature of the care or services required, 

2 or a combination of those factors make the use of facilities 

3 of the Department, contracts, or sharing agreements im4 practicable or inadvisable. 

5 ‘‘(3) Eligibility of a veteran under this section for the 

6 care or services described in paragraph (1) shall be deter7 mined as if such care or services were furnished in a facil8 ity of the Department and provisions of this title applica9 ble to veterans receiving such care or services in a facility 

10 of the Department shall apply to veterans receiving such 

11 care or services under this section. 

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

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

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

15 and entered into a provider agreement under section 

16 1866(a) of the Social Security Act (42 U.S.C. 

17 1395cc(a)). 

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

19 and entered into a participation agreement under 

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

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

22 payment under a State plan under title XIX of such 

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

24 plan. 

25 ‘‘(4) A provider that is— 


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1 ‘‘(A) an Aging and Disability Resource 

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

3 agency (as defined in section 102 of the Older 

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

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

6 defined in section 702 of the Rehabilitation Act 

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

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

9 Secretary considers appropriate for purposes of this 

10 section. 

11 ‘‘(c) CERTIFICATION OF ELIGIBLE PROVIDERS.—(1) 

12 The Secretary shall establish a process for the certification 

13 of eligible providers under this section that shall, at a min14 imum, set forth the following: 

15 ‘‘(A) Procedures for the submittal of applica16 tions for certification and deadlines for actions taken 

17 by the Secretary with respect to such applications. 

18 ‘‘(B) Standards and procedures for approval 

19 and denial of certification, duration of certification, 

20 revocation of certification, and recertification. 

21 ‘‘(C) Procedures for assessing eligible providers 

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

23 providers similar to the level of screening under sec24 tion 1866(j)(2)(B) of the Social Security Act (42 

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


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1 under section 9.104 of title 48, Code of Federal 

2 Regulations, or any successor regulation. 

3 ‘‘(2) The Secretary shall deny or revoke certification 

4 to an eligible provider under this subsection if the Sec5 retary determines that the eligible provider is currently— 

6 ‘‘(A) excluded from participation in a Federal 

7 health care program (as defined in section 1128B(f) 

8 of the Social Security Act (42 U.S.C. 1320a–7b(f))) 

9 under section 1128 or 1128A of the Social Security 

10 Act (42 U.S.C. 1320a–7 and 1320a–7a); or 

11 ‘‘(B) identified as an excluded source on the list 

12 maintained in the System for Award Management, 

13 or any successor system. 

14 ‘‘(d) TERMS OF AGREEMENTS.—Each agreement en15 tered into with an eligible provider under this section shall 

16 include provisions requiring the eligible provider to do the 

17 following: 

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

19 furnished under this section at rates established by 

20 the Secretary for purposes of this section, which 

21 shall be, to the extent practicable, the rates paid by 

22 the United States for such care and services to pro23 viders of services and suppliers under the Medicare 

24 program under title XVIII of the Social Security Act 

25 (42 U.S.C. 1395 et seq.). 


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

2 payment in full for care and services furnished 

3 under this section and to not seek any payment for 

4 such care and services from the recipient of such 

5 care and services. 

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

7 and services authorized by the Department under 

8 this section unless the eligible provider receives prior 

9 written consent from the Department to furnish care 

10 or services outside the scope of such authorization. 

11 ‘‘(4) To bill the Department for care and serv12 ices furnished under this section in accordance with 

13 a methodology established by the Secretary for pur14 poses of this section. 

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

16 health-plan contract or third party, as those terms 

17 are defined in section 1729 of this title, for any care 

18 or services for which payment is made by the De19 partment under this section. 

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

21 furnished care or services under this section to the 

22 Department in a timeframe and format specified by 

23 the Secretary for purposes of this section. 


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

2 including quality of care assurance standards, as the 

3 Secretary may specify for purposes of this section. 

4 ‘‘(e) TERMINATION OF AGREEMENTS.—(1) An eligi5 ble provider may terminate an agreement with the Sec6 retary under this section at such time and upon such no7 tice to the Secretary as the Secretary may specify for pur8 poses of this section. 

9 ‘‘(2) The Secretary may terminate an agreement with 

10 an eligible provider under this section at such time and 

11 upon such notice to the eligible provider as the Secretary 

12 may specify for purposes of this section, if the Secretary— 

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

14 to comply substantially with the provisions of the 

15 agreement or with the provisions of this section and 

16 the regulations prescribed thereunder; 

17 ‘‘(B) determines that the eligible provider is— 

18 ‘‘(i) excluded from participation in a Fed19 eral health care program (as defined in section 

20 1128B(f) of the Social Security Act (42 U.S.C. 

21 1320a–7b(f))) under section 1128 or 1128A of 

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

23 and 1320a–7a); or 


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

2 the list maintained in the System for Award 

3 Management, or any successor system; 

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

5 been convicted of a felony or other serious offense 

6 under Federal or State law and determines that the 

7 continued participation of the eligible provider would 

8 be detrimental to the best interests of veterans or 

9 the Department; or 

10 ‘‘(D) determines that it is reasonable to termi11 nate the agreement based on the health care needs 

12 of a veteran or veterans. 

13 ‘‘(f) PERIODIC REVIEW OF CERTAIN AGREE14 MENTS.—(1) Not less frequently than once every two 

15 years, the Secretary shall review each Veterans Care 

16 Agreement of material size entered into during the two17 year period preceding the review to determine whether it 

18 is feasible and advisable to furnish the hospital care, med19 ical services, or extended care furnished under such agree20 ment at facilities of the Department or through contracts 

21 or sharing agreements entered into under authorities other 

22 than this section. 

23 ‘‘(2)(A) Subject to subparagraph (B), a Veterans 

24 Care Agreement is of material size as determined by the 

25 Secretary for purposes of this section. 


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1 ‘‘(B) A Veterans Care Agreement entered into after 

2 September 30, 2018, for the purchase of extended care 

3 services is of material size if the purchase of such services 

4 under the agreement exceeds $1,000,000 annually. The 

5 Secretary may adjust such amount to account for changes 

6 in the cost of health care based upon recognized health 

7 care market surveys and other available data and shall 

8 publish any such adjustments in the Federal Register. 

9 ‘‘(g) TREATMENT OF CERTAIN LAWS.—(1) An agree10 ment under this section may be entered into without re11 gard to any law that would require the Secretary to use 

12 competitive procedures in selecting the party with which 

13 to enter into the agreement. 

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

15 unless otherwise provided in this section or regulations 

16 prescribed pursuant to this section, an eligible provider 

17 that enters into an agreement under this section is not 

18 subject to, in the carrying out of the agreement, any law 

19 that an eligible provider described in subsection (b)(1), 

20 (b)(2), or (b)(3) is not subject to under the original Medi21 care fee-for-service program under parts A and B of title 

22 XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 

23 or the Medicaid program under title XIX of such Act (42 

24 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 ‘‘(h) MONITORING OF QUALITY OF CARE.—The Sec12 retary shall establish a system or systems, consistent with 

13 survey and certification procedures used by the Centers 

14 for Medicare & Medicaid Services and State survey agen15 cies to the extent practicable— 

16 ‘‘(1) to monitor the quality of care and services 

17 furnished to veterans under this section; and 

18 ‘‘(2) to assess the quality of care and services 

19 furnished by an eligible provider for purposes of de20 termining whether to renew an agreement under this 

21 section with the eligible provider. 

22 ‘‘(i) DISPUTE RESOLUTION.—(1) The Secretary shall 

23 establish administrative procedures for eligible providers 

24 with which the Secretary has entered an agreement under 


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1 this section to present any dispute arising under or related 

2 to the agreement. 

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

4 under chapter 71 of title 41 with respect to a dispute aris5 ing under an agreement under this section, an eligible pro6 vider must first exhaust the administrative procedures es7 tablished by the Secretary under paragraph (1).’’. 

8 (b) REGULATIONS.—The Secretary of Veterans Af9 fairs shall prescribe an interim final rule to carry out sec10 tion 1703A of such title, as added by subsection (a), not 

11 later than one year after the date of the enactment of this 

12 Act. 

13 (c) CLERICAL AMENDMENT.—The table of sections 

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

15 by inserting after the item related to section 1703 the fol16 lowing new item: 

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

17 SEC. 4. MODIFICATION OF AUTHORITY TO ENTER INTO 

18 AGREEMENTS TO PROVIDE NURSING HOME 

19 CARE. 

20 (a) USE OF AGREEMENTS.— 

21 (1) IN GENERAL.—Paragraph (1) of section 

22 1745(a) of title 38, United States Code, is amended, 

23 in the matter preceding subparagraph (A), by strik24 ing ‘‘a contract (or agreement under section 


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1 1720(c)(1) of this title)’’ and inserting ‘‘an agree2 ment’’. 

3 (2) PAYMENT.—Paragraph (2) of such section 

4 is amended by striking ‘‘contract (or agreement)’’ 

5 each place it appears and inserting ‘‘agreement’’. 

6 (b) EXCLUSION OF CERTAIN FEDERAL CON7 TRACTING PROVISIONS.—Such section is amended by add8 ing at the end the following new paragraph: 

9 ‘‘(4)(A) An agreement under this section may be en10 tered into without regard to any law that would require 

11 the Secretary to use competitive procedures in selecting 

12 the party with which to enter into the agreement. 

13 ‘‘(B)(i) Except as provided in clause (ii) and unless 

14 otherwise provided in this section or regulations prescribed 

15 pursuant to this section, a State home that enters into 

16 an agreement under this section is not subject to, in the 

17 carrying out of the agreement, any law that a provider 

18 described in subparagraph (D) is not subject to under the 

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

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

21 1395 et seq.) or the Medicaid program under title XIX 

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

23 ‘‘(ii) The exclusion under clause (i) does not apply 

24 to laws regarding integrity, ethics, fraud, or that subject 

25 a person to civil or criminal penalties. 


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1 ‘‘(C) Title VII of the Civil Rights Act of 1964 (42 

2 U.S.C. 2000e et seq.) shall apply with respect to any State 

3 home that enters into an agreement under this section. 

4 ‘‘(D) A provider described in this subparagraph is 

5 one of the following: 

6 ‘‘(i) A provider of services that has enrolled and 

7 entered into a provider agreement under section 

8 1866(a) of the Social Security Act (42 U.S.C. 

9 1395cc(a)). 

10 ‘‘(ii) A physician or supplier that has enrolled 

11 and entered into a participation agreement under 

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

13 ‘‘(iii) A provider of items and services receiving 

14 payment under a State plan under title XIX of such 

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

16 plan.’’. 

17 (c) EFFECTIVE DATE.—The amendments made by 

18 this section shall apply to agreements entered into under 

19 section 1745 of such title on and after the date that is 

20 30 days after the date of the enactment of this Act. 

Æ 


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