I 

115TH CONGRESS 

1ST SESSION H. R. 4242 

To amend title 38, United States Code, to establish a permanent VA Care 

in the Community Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 3, 2017 

Mr. ROE of Tennessee (for himself, Mr. COFFMAN, Mr. WENSTRUP, Mrs. 

RADEWAGEN, Mr. BOST, Mr. POLIQUIN, Mr. ARRINGTON, Mr. RUTHERFORD, Mr. HIGGINS of Louisiana, Mr. BERGMAN, Mr. BANKS of Indiana, 

Miss GONZA ́LEZ-COLO ́N of Puerto Rico, Mr. BILIRAKIS, Mr. DUNN, Mr. 

WALZ, Ms. KUSTER of New Hampshire, Miss RICE of New York, Mr. 

CORREA, Mr. SABLAN, Ms. ESTY of Connecticut, Mr. PETERS, Mr. 

O’ROURKE, Mr. TAKANO, and Ms. BROWNLEY of California) introduced 

the following bill; which was referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to establish a permanent VA Care in the Community Program, 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 ‘‘VA Care in the Community Act’’. 


ethrower on DSK3G9T082PROD with BILLS
2 

•HR 4242 IH

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

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—IMPROVED ACCESS FOR VETERANS TO NONDEPARTMENT OF VETERANS AFFAIRS MEDICAL CARE 

Sec. 101. Assignment of veterans to primary care providers. 

Sec. 102. Establishment of VA Care in the Community Program. 

Sec. 103. Veterans Care Agreements. 

Sec. 104. Modification of authority to enter into agreements with State homes 

to provide nursing home care. 

Sec. 105. Department of Veterans Affairs electronic interface for processing of 

medical claims. 

Sec. 106. Funding for VA Care in the Community Program. 

Sec. 107. Termination of certain provisions authorizing medical care to veterans through non-Department of Veterans Affairs providers. 

Sec. 108. Implementation and transition. 

TITLE II—OTHER ADMINISTRATIVE MATTERS 

Sec. 201. Reimbursement for emergency ambulance services. 

Sec. 202. Improvement of care coordination for veterans through exchange of 

certain medical records. 

Sec. 203. Elimination of copayment offset. 

Sec. 204. Use of Department of Veterans Affairs Medical Care Collections 

Fund for certain improvements in collections. 

Sec. 205. Department of Veterans Affairs health care productivity improvement. 

Sec. 206. Licensure of health care professionals of the Department of Veterans 

Affairs providing treatment via telemedicine. 

3 TITLE I—IMPROVED ACCESS 

4 FOR VETERANS TO NON-DE5 PARTMENT OF VETERANS AF6 FAIRS MEDICAL CARE 

7 SEC. 101. ASSIGNMENT OF VETERANS TO PRIMARY CARE 

8 PROVIDERS. 

9 Section 1706 of title 38, United States Code, is 

10 amended by adding at the end the following new sub11 section: 


ethrower on DSK3G9T082PROD with BILLS
3 

•HR 4242 IH

1 ‘‘(d)(1) Except as provided in section 1703A of this 

2 title, in furnishing primary care under this chapter, the 

3 Secretary shall assign each eligible veteran to— 

4 ‘‘(A) a patient-aligned care team of the Depart5 ment; or 

6 ‘‘(B) a dedicated primary care provider of the 

7 Department as a part of any other model of pro8 viding consistent primary care determined appro9 priate by the Secretary. 

10 ‘‘(2) Each patient-aligned care team of the Depart11 ment shall consist of a team of health care professionals 

12 of the Department who— 

13 ‘‘(A) provide to each eligible veteran com14 prehensive primary care in partnership with the vet15 eran; and 

16 ‘‘(B) manage and coordinate comprehensive 

17 hospital care and medical services consistent with 

18 the goals of care agreed upon by the veteran and 

19 team. 

20 ‘‘(3) The Secretary shall ensure that an eligible vet21 eran is not simultaneously assigned to more than one pa22 tient-aligned care team or dedicated primary care provider 

23 under this subsection at a single location, including by es24 tablishing procedures in the event a primary care provider 

25 retires or is otherwise no longer able to treat the veteran. 


ethrower on DSK3G9T082PROD with BILLS
4 

•HR 4242 IH

1 In the case of an eligible veteran who resides in more than 

2 one location, the Secretary may assign such veteran to a 

3 patient-aligned care team or dedicated primary care pro4 vider at each such location. 

5 ‘‘(4) The term ‘eligible veteran’ means a veteran 

6 who— 

7 ‘‘(A) is enrolled in the patient enrollment sys8 tem of the Department established and operated 

9 under section 1705(a) of this title; and 

10 ‘‘(B) has— 

11 ‘‘(i) been furnished hospital care or med12 ical services at or through a Department facility 

13 on at least one occasion during the two-year pe14 riod preceding the date of the determination of 

15 eligibility; or 

16 ‘‘(ii) requested a first-time appointment for 

17 hospital care or medical services at a Depart18 ment facility.’’. 

19 SEC. 102. ESTABLISHMENT OF VA CARE IN THE COMMU20 NITY PROGRAM. 

21 (a) ESTABLISHMENT OF PROGRAM.— 

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

23 United States Code, is amended by inserting after 

24 section 1703 the following new section: 


ethrower on DSK3G9T082PROD with BILLS
5 

•HR 4242 IH

1 ‘‘§ 1703A. VA Care in the Community Program 

2 ‘‘(a) PROGRAM.—(1) Subject to the availability of ap3 propriations for such purpose, hospital care, medical serv4 ices, and extended care services under this chapter shall 

5 be furnished to an eligible veteran through contracts or 

6 agreements authorized under subsection (d), or contracts 

7 or agreements, including national contracts or agree8 ments, authorized under section 8153 of this title or any 

9 other provision of law administered by the Secretary, with 

10 network providers for the furnishing of such care and serv11 ices to veterans. 

12 ‘‘(2) Subject to subsection (b), an eligible veteran 

13 may select a provider of such care or services from among 

14 network providers. 

15 ‘‘(3) The Secretary shall coordinate the furnishing of 

16 care and services under this section to eligible veterans. 

17 ‘‘(4)(A) In carrying out this section, the Secretary 

18 shall establish regional networks of network providers. 

19 The Secretary shall determine, and may modify, such re20 gions based on the capacity and market assessments of 

21 Veterans Integrated Service Networks conducted under 

22 subsection (k) or upon recognized need. 

23 ‘‘(B) The Secretary may enter into one or more con24 tracts for the purposes of managing the operations of the 

25 regional networks and for the delivery of care pursuant 

26 to this section. 


ethrower on DSK3G9T082PROD with BILLS
6 

•HR 4242 IH

1 ‘‘(b) PRIMARY AND SPECIALTY CARE.—(1)(A) If the 

2 Secretary is unable to assign an eligible veteran to a pa3 tient-aligned care team or dedicated primary care provider 

4 under section 1706(d) of this title because the Secretary 

5 determines such a care team or provider at a Department 

6 facility is not available— 

7 ‘‘(i) the Secretary shall consult with the veteran 

8 regarding available primary care providers from 

9 among network providers that are located in the re10 gional network in which the veteran resides or a re11 gional network that is adjacent to the regional net12 work in which the veteran resides; and 

13 ‘‘(ii) the veteran may select one of the available 

14 primary care providers to serve as the dedicated pri15 mary care provider of the veteran. 

16 ‘‘(B) In determining whether a patient-aligned care 

17 team or dedicated provider under section 1706(d) of this 

18 title is available for assignment to a veteran, the Secretary 

19 shall take into consideration each of the following: 

20 ‘‘(i) Whether the veteran faces an unusual or 

21 excessive burden in accessing such patient-aligned 

22 care team or dedicated provider at a medical facility 

23 of the Department including with respect to— 

24 ‘‘(I) geographical challenges; 


ethrower on DSK3G9T082PROD with BILLS
7 

•HR 4242 IH

1 ‘‘(II) environmental factors, including 

2 roads that are not accessible to the general pub3 lic, traffic, or hazardous weather; 

4 ‘‘(III) a medical condition of the veteran; 

5 or 

6 ‘‘(IV) such other factors as determined by 

7 the Secretary. 

8 ‘‘(ii) Whether the veteran reasonably believes 

9 that the assignment of a particular care team or 

10 provider to the veteran would detrimentally affect 

11 the patient-provider relationship and result in sub12 optimal care to the veteran. 

13 ‘‘(iii) Whether the panel size of the care team 

14 or provider is at such a number that it would result 

15 in difficulty for the veteran in accessing timely care 

16 or in sub-optimal care to the veteran. 

17 ‘‘(C) If the Secretary determines that a patient18 aligned care team or dedicated primary care provider at 

19 a Department facility has become available for assignment 

20 to an eligible veteran who had been assigned to a network 

21 provider under subparagraph (A), the Secretary shall pro22 vide the veteran with the option of reassignment to the 

23 team or provider at the Department facility. 

24 ‘‘(D) In the case of an eligible veteran who is as25 signed to a network provider under subparagraph (A), the 


ethrower on DSK3G9T082PROD with BILLS
8 

•HR 4242 IH

1 Secretary shall reevaluate such assignment not earlier 

2 than one year after a veteran makes a selection under sub3 paragraph (A)(ii), and on an annual basis thereafter, to— 

4 ‘‘(i) determine whether the Secretary is able to 

5 assign to the veteran a patient-aligned care team or 

6 dedicated primary care provider under section 

7 1706(d) of this title; and 

8 ‘‘(ii) in consultation with and upon approval of 

9 the veteran, make such assignment if able. 

10 ‘‘(2)(A)(i) Except as provided in clause (ii), the Sec11 retary may only furnish specialty hospital care, medical 

12 services, or extended care services to an eligible veteran 

13 under this section pursuant to a referral for such specialty 

14 care or services made by the primary care provider of the 

15 veteran. 

16 ‘‘(ii) The Secretary may designate specialties which 

17 shall be exempt from the requirement under clause (i). 

18 ‘‘(B) The Secretary shall determine whether to fur19 nish specialty hospital care, medical services, or extended 

20 care services to an eligible veteran pursuant to subpara21 graph (A)— 

22 ‘‘(i) at a medical facility of the Department 

23 that is within a reasonable distance of the residence 

24 of the veteran, as determined by the Secretary; 


ethrower on DSK3G9T082PROD with BILLS
9 

•HR 4242 IH

1 ‘‘(ii) by a network provider that, to the greatest 

2 extent practicable, is located in the regional network 

3 in which the veteran resides or a regional network 

4 that is adjacent to the regional network in which the 

5 veteran resides; or 

6 ‘‘(iii) pursuant to an agreement described in 

7 subparagraph (C). 

8 ‘‘(C) An agreement described in this subparagraph 

9 is an agreement entered into by the Secretary with a net10 work provider under which— 

11 ‘‘(i) specialty hospital care, medical services, or 

12 extended care services are furnished to an eligible 

13 veteran pursuant to subparagraph (A)— 

14 ‘‘(I) at a medical facility of the Depart15 ment by a network provider possessing the ap16 propriate credentials, as determined by the Sec17 retary; or 

18 ‘‘(II) at a facility of a network provider by 

19 a health care provider of the Department; and 

20 ‘‘(ii) such specialty care or services are so fur21 nished either— 

22 ‘‘(I) in accordance with this section with 

23 respect to fees and payments for care and serv24 ices furnished under subsection (a); or 

25 ‘‘(II) at no cost to the United States. 


ethrower on DSK3G9T082PROD with BILLS
10 

•HR 4242 IH

1 ‘‘(D) In making the determination under subpara2 graph (B), the Secretary shall give priority to medical fa3 cilities and health care providers of the Department but 

4 shall take into account— 

5 ‘‘(i) whether the veteran faces an unusual or ex6 cessive burden in accessing such specialty hospital 

7 care, medical services, or extended care services at 

8 a medical facility of the Department, including with 

9 respect to— 

10 ‘‘(I) geographical challenges; 

11 ‘‘(II) environmental factors, such as roads 

12 that are not accessible to the general public, 

13 traffic, or hazardous weather; 

14 ‘‘(III) a medical condition of the veteran; 

15 or 

16 ‘‘(IV) such other factors as determined by 

17 the Secretary; and 

18 ‘‘(ii) whether the primary care provider of the 

19 veteran recommends that such specialty hospital 

20 care, medical services, or extended care services 

21 should be furnished by a network provider. 

22 ‘‘(E) The Secretary shall ensure that each medical 

23 facility of the Department processes referrals for specialty 

24 hospital care, medical services, or extended care services 

25 in a standardized manner, including with respect to the 


ethrower on DSK3G9T082PROD with BILLS
11 

•HR 4242 IH

1 organization of the program office responsible for such re2 ferrals. 

3 ‘‘(F) In carrying out this section, the Secretary shall 

4 establish a process to review any disagreement between an 

5 eligible veteran and the Department, or between an eligi6 ble veteran and a health care provider of the Department, 

7 regarding the eligibility of the veteran to receive care or 

8 services from a network provider under this section or the 

9 assignment of a primary care provider of the Department 

10 to the veteran. In reviewing a disagreement under such 

11 process with respect to the availability of and assignment 

12 to a patient aligned care team or dedicated primary care 

13 provider, the Secretary shall give deference to the veteran 

14 with respect to any determination under subsection 

15 (b)(1)(B)(ii). 

16 ‘‘(c) EPISODES OF CARE.—(1) The Secretary shall 

17 ensure that, at the election of an eligible veteran who re18 ceives hospital care, medical services, or extended care 

19 services from a network provider in an episode of care 

20 under this section, the veteran receives such care or serv21 ices from that network provider, another network provider 

22 selected by the veteran, or a health care provider of the 

23 Department, through the completion of the episode of 

24 care, including all specialty and ancillary services deter25 mined necessary by the provider as part of the treatment 


ethrower on DSK3G9T082PROD with BILLS
12 

•HR 4242 IH

1 recommended in the course of such care or services. In 

2 making such determination with respect to necessary spe3 cialty and ancillary services provided by a network pro4 vider, the network provider shall consult with the Sec5 retary, acting through the program office of the appro6 priate medical facility. 

7 ‘‘(2) In cases of episodes of care that the Secretary 

8 determines case management to be appropriate, the Sec9 retary shall provide case management to an eligible vet10 eran who receives hospital care, medical services, or ex11 tended care services from a network provider for such epi12 sodes of care. The Secretary may provide such case man13 agement through the Veterans Health Administration or 

14 through an entity that manages the operations of the re15 gional networks pursuant to subsection (a)(4)(B). 

16 ‘‘(d) CARE AND SERVICES THROUGH CONTRACTS

17 AND AGREEMENTS.—(1) The Secretary shall enter into 

18 contracts or agreements, including national contracts or 

19 agreements for, but not limited to, dialysis, for furnishing 

20 care and services to eligible veterans under this section 

21 with network providers. 

22 ‘‘(2)(A) In entering into a contract or agreement 

23 under paragraph (1) with a network provider, the Sec24 retary shall— 


ethrower on DSK3G9T082PROD with BILLS
13 

•HR 4242 IH

1 ‘‘(i) negotiate rates for the furnishing of care 

2 and services under this section; and 

3 ‘‘(ii) reimburse the provider for such care and 

4 services at the rates negotiated pursuant to clause 

5 (i) as provided in such contract or agreement. 

6 ‘‘(B)(i) Except as provided in paragraph (3), rates 

7 negotiated under subparagraph (A)(i) shall not be more 

8 than the rates paid by the United States to a provider 

9 of services (as defined in section 1861(u) of the Social Se10 curity Act (42 U.S.C. 1395x(u))) or a supplier (as defined 

11 in section 1861(d) of such Act (42 U.S.C. 1395x(d))) 

12 under the Medicare Program under title XVIII of the So13 cial Security Act (42 U.S.C. 1395 et seq.) for the same 

14 care or services. 

15 ‘‘(ii) In determining the rates under the Medicare 

16 Program under title XVIII of the Social Security Act (42 

17 U.S.C. 1395 et seq.) for purposes of clause (i), in the case 

18 of care or services furnished by a provider of services with 

19 respect to which such rates are determined under a fee 

20 schedule to which the area wage index under section 

21 1886(d)(3)(E) of the Social Security Act (42 U.S.C. 

22 1395ww(d)(3)(E)) applies, such area wage index so ap23 plied to such provider of services may not be less than 

24 1.00. 


ethrower on DSK3G9T082PROD with BILLS
14 

•HR 4242 IH

1 ‘‘(C) In carrying out paragraph (2), the Secretary 

2 may incorporate the use of value-based reimbursement 

3 models to promote the provision of high-quality care. 

4 ‘‘(3)(A) With respect to the furnishing of care or 

5 services under this section to an eligible veteran who re6 sides in a highly rural area (as defined under the rural7 urban commuting area codes developed by the Secretary 

8 of Agriculture and the Secretary of Health and Human 

9 Services), the Secretary of Veterans Affairs may negotiate 

10 a rate that is more than the rate paid by the United States 

11 as described in paragraph (2)(B). 

12 ‘‘(B) With respect to furnishing care or services 

13 under this section in Alaska, the Alaska Fee Schedule of 

14 the Department of Veterans Affairs will be followed, ex15 cept for when another payment agreement, including a 

16 contract or provider agreement, is in place. 

17 ‘‘(C) With respect to furnishing care or services 

18 under this section in a State with an All-Payer Model 

19 Agreement under the Social Security Act that became ef20 fective on or after January 1, 2014, the Medicare payment 

21 rates under paragraph (2)(B) shall be calculated based on 

22 the payment rates under such agreement, or any such suc23 cessor agreement. 

24 ‘‘(D) With respect to furnishing care or services 

25 under this section in a location in which the Secretary deVerDate Sep 11 2014 21:31 Nov 06, 2017 Jkt 079200 PO 00000 Frm 00014 Fmt 6652 Sfmt 6201 E:\BILLS\H4242.IH H4242

ethrower on DSK3G9T082PROD with BILLS
15 

•HR 4242 IH

1 termines that adjusting the rate paid by the United States 

2 as described in paragraph (2)(B) is appropriate, the Sec3 retary may negotiate such an adjusted rate. 

4 ‘‘(E) With respect to furnishing care or services 

5 under this section in a location or in a situation in which 

6 an exception to the rates paid by the United States under 

7 the Medicare Program under title XVIII of the Social Se8 curity Act (42 U.S.C. 1395 et seq.) for the same care or 

9 services applies, the Secretary may follow such exception. 

10 ‘‘(F) With respect to furnishing care or services 

11 under this section for care or services not covered under 

12 the Medicare Program under title XVIII of the Social Se13 curity Act (42 U.S.C. 1395 et seq.), the Secretary shall 

14 establish a schedule of fees for such care or services. 

15 ‘‘(G) With respect to furnishing care or services 

16 under this section pursuant to an agreement with a tribal 

17 or Federal entity, the Secretary may negotiate a rate that 

18 is more than the rate paid by the United States as de19 scribed in paragraph (2)(B). 

20 ‘‘(4) For the furnishing of care or services pursuant 

21 to a contract or agreement under paragraph (1), a net22 work provider may not collect any amount that is greater 

23 than the rate negotiated pursuant to paragraph (2)(A). 

24 ‘‘(5)(A) If, in the course of an episode of care under 

25 this section, any part of care or services is furnished by 


ethrower on DSK3G9T082PROD with BILLS
16 

•HR 4242 IH

1 a medical provider who is not a network provider, the Sec2 retary may compensate such provider for furnishing such 

3 care or services. 

4 ‘‘(B) The Secretary shall make reasonable efforts to 

5 enter into a contract or agreement under this section with 

6 any provider who is compensated pursuant to subpara7 graph (A). 

8 ‘‘(e) PROMPT PAYMENT STANDARD.—(1) The Sec9 retary shall ensure that claims for payments for hospital 

10 care, medical services, or extended care services furnished 

11 under this section are processed in accordance with this 

12 subsection, regardless of whether such claims are— 

13 ‘‘(A) made by a network provider to the Sec14 retary; 

15 ‘‘(B) made by a network provider to a regional 

16 network operated by a contractor pursuant to sub17 section (a)(4)(B); or 

18 ‘‘(C) made by such a regional network to the 

19 Secretary. 

20 ‘‘(2) A covered claimant that seeks payment for hos21 pital care, medical services, or extended care services fur22 nished under this section shall submit to the covered payer 

23 a claim for payment not later than— 


ethrower on DSK3G9T082PROD with BILLS
17 

•HR 4242 IH

1 ‘‘(A) with respect to a claim by a network pro2 vider, 180 days after the date on which the network 

3 provider furnishes such care or services; or 

4 ‘‘(B) with respect to a claim by a regional net5 work operated by a contractor, 180 days after the 

6 date on which the contractor pays the network pro7 vider for furnishing such care or services. 

8 ‘‘(3) Notwithstanding chapter 39 of title 31 or any 

9 other provision of law, the covered payer shall pay a cov10 ered claimant for hospital care, medical services, or ex11 tended care services furnished under this section— 

12 ‘‘(A) in the case of a clean claim submitted to 

13 the covered payer on paper, not later than 45 cal14 endar days after receiving the claim; or 

15 ‘‘(B) in the case of a clean claim submitted to 

16 the covered payer electronically, not later than 30 

17 calendar days after receiving the claim. 

18 ‘‘(4)(A) If the covered payer denies a claim submitted 

19 by a covered claimant under paragraph (1), the covered 

20 payer shall notify the covered claimant of the reason for 

21 denying the claim and the additional information, if any, 

22 that may be required to process the claim— 

23 ‘‘(i) in the case of a clean claim submitted to 

24 the covered payer on paper, not later than 45 cal25 endar days after receiving the claim; or 


ethrower on DSK3G9T082PROD with BILLS
18 

•HR 4242 IH

1 ‘‘(ii) in the case of a clean claim submitted to 

2 the covered payer electronically, not later than 30 

3 calendar days after receiving the claim. 

4 ‘‘(B) Upon receipt by the covered payer of additional 

5 information specified under subparagraph (A) relating to 

6 a claim, the covered payer shall pay, deny, or otherwise 

7 adjudicate the claim, as appropriate, not later than 30 cal8 endar days after receiving such information. 

9 ‘‘(5)(A) If the covered payer has not paid a covered 

10 claimant or denied a clean claim for payment by the cov11 ered claimant under this subsection during the appro12 priate period specified in this subsection, such clean claim 

13 shall be considered overdue. 

14 ‘‘(B) If a clean claim for payment by a covered claim15 ant is considered overdue under subparagraph (A), in ad16 dition to the amount the covered payer owes the covered 

17 claimant under the claim, the covered payer shall owe the 

18 covered claimant an interest penalty amount that shall— 

19 ‘‘(i) be prorated daily; 

20 ‘‘(ii) accrue from the date the payment was 

21 overdue; 

22 ‘‘(iii) be payable at the time the claim is paid; 

23 and 

24 ‘‘(iv) be computed at the rate of interest estab25 lished by the Secretary of the Treasury, and pubVerDate Sep 11 2014 21:31 Nov 06, 2017 Jkt 079200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H4242.IH H4242

ethrower on DSK3G9T082PROD with BILLS
19 

•HR 4242 IH

1 lished in the Federal Register, for interest payments 

2 under subsections (a)(1) and (b) of section 7109 of 

3 title 41 that is in effect at the time the covered 

4 payer accrues the obligation to pay the interest pen5 alty amount. 

6 ‘‘(6)(A) If the covered payer overpays a covered 

7 claimant for hospital care, medical services, or extended 

8 care services furnished under this section— 

9 ‘‘(i) the covered payer shall deduct the amount 

10 of any overpayment from payments due to the cov11 ered claimant after the date of such overpayment; or 

12 ‘‘(ii) if the covered payer determines that there 

13 are no such payments due after the date of the over14 payment, the covered claimant shall refund the 

15 amount of such overpayment not later than 30 days 

16 after such determination. 

17 ‘‘(B)(i) Before deducting any amount from a pay18 ment to a covered claimant under subparagraph (A), the 

19 covered payer shall ensure that the covered claimant is 

20 provided an opportunity— 

21 ‘‘(I) to dispute the existence or amount of any 

22 overpayment owed to the covered payer; and 

23 ‘‘(II) to request a compromise with respect to 

24 any such overpayment. 


ethrower on DSK3G9T082PROD with BILLS
20 

•HR 4242 IH

1 ‘‘(ii) The covered payer may not make any deduction 

2 from a payment to a covered claimant under subparagraph 

3 (A) unless the covered payer has made reasonable efforts 

4 to notify the covered claimant of the rights of the covered 

5 claimant under subclauses (I) and (II) of clause (i). 

6 ‘‘(iii) Upon receiving a dispute under subclause (I) 

7 of clause (i) or a request under subclause (II) of such 

8 clause, the covered payer shall make a determination with 

9 respect to such dispute or request before making any de10 duction under subparagraph (A) unless the time required 

11 to make such a determination would jeopardize the ability 

12 of the covered payer to recover the full amount owed to 

13 the covered payer. 

14 ‘‘(7) Notwithstanding any other provision of law, the 

15 Secretary may, except in the case of a fraudulent claim, 

16 false claim, or misrepresented claim, compromise any 

17 claim of an amount owed to the United States under this 

18 section. 

19 ‘‘(8) This subsection shall apply only to payments 

20 made on a claims basis and not to capitation or other 

21 forms of periodic payments to network providers. 

22 ‘‘(9) A network provider that provides hospital care, 

23 medical services, or extended care services to an eligible 

24 veteran under this section may not seek any payment for 

25 such care or services from the eligible veteran. 


ethrower on DSK3G9T082PROD with BILLS
21 

•HR 4242 IH

1 ‘‘(10) With respect to making a payment for hospital 

2 care or medical services furnished to an eligible veteran 

3 by a network provider under this section— 

4 ‘‘(A) the Secretary may not require receipt by 

5 the veteran or the Department of a medical record 

6 under subsection (g) detailing such care or services 

7 before a covered payer makes a payment for such 

8 care or services; and 

9 ‘‘(B) the Secretary may require that the net10 work provider attests to such care or services so pro11 vided before a covered payer makes a payment for 

12 such care or services. 

13 ‘‘(f) COST-SHARING.—(1) The Secretary shall require 

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

15 care or services under this section only if such eligible vet16 eran would be required to pay a copayment for the receipt 

17 of such care or services at a medical facility of the Depart18 ment or from a health care provider of the Department 

19 under this chapter. 

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

21 paragraph (1) may not exceed the amount of the copay22 ment that would be payable by such eligible veteran for 

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

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

25 Department under this chapter. 


ethrower on DSK3G9T082PROD with BILLS
22 

•HR 4242 IH

1 ‘‘(3) In any case in which an eligible veteran is fur2 nished hospital care or medical services under this section 

3 for a non-service-connected disability described in sub4 section (a)(2) of section 1729 of this title, the Secretary 

5 shall recover or collect reasonable charges for such care 

6 or services from a health-plan contract described in section 

7 1705A in accordance with such section 1729. 

8 ‘‘(g) MEDICAL RECORDS.—(1) The Secretary shall 

9 ensure that any network provider that furnishes care or 

10 services under this section to an eligible veteran— 

11 ‘‘(A) upon the request of the veteran, provides 

12 to the veteran the medical records related to such 

13 care or services; and 

14 ‘‘(B) upon the completion of the provision of 

15 such care or services to such veteran, provides to the 

16 Department the medical records for the veteran fur17 nished care or services under this section in a time18 frame and format specified by the Secretary for pur19 poses of this section, except the Secretary may not 

20 require that any payment by the Secretary to the eli21 gible provider be contingent on such provision of 

22 medical records. 

23 ‘‘(2) To the extent practicable, the Secretary shall 

24 submit to a network provider that furnishes care or serv25 ices under this section to an eligible veteran the medical 


ethrower on DSK3G9T082PROD with BILLS
23 

•HR 4242 IH

1 records of such eligible veteran that are maintained by the 

2 Department and are relevant to such care or services. 

3 ‘‘(3) To the extent practicable, the Secretary shall— 

4 ‘‘(A) ensure that the medical records shared 

5 under paragraphs (1) and (2) are shared in an elec6 tronic format accessible by network providers and 

7 the Department through an Internet website; and 

8 ‘‘(B) provide to network providers access to the 

9 electronic patient health record system of the De10 partment, or successor system, for the purpose of 

11 furnishing care or services under this section. 

12 ‘‘(h) USE OF CARD.—The Secretary shall ensure that 

13 the veteran health identification card, or such successor 

14 identification card, includes sufficient information to act 

15 as an identification card for an eligible entity or other non16 Department facility. The Secretary may not use any 

17 amounts made available to the Secretary to issue separate 

18 identification cards solely for the purpose of carrying out 

19 this section. 

20 ‘‘(i) PRESCRIPTION MEDICATIONS.—(1) With respect 

21 to requirements relating to the licensing or credentialing 

22 of a network provider, the Secretary shall ensure that the 

23 network provider is able to submit prescriptions for phar24 maceutical agents on the formulary of the Department to 

25 pharmacies of the Department in a manner that is subVerDate Sep 11 2014 21:31 Nov 06, 2017 Jkt 079200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6201 E:\BILLS\H4242.IH H4242

ethrower on DSK3G9T082PROD with BILLS
24 

•HR 4242 IH

1 stantially similar to the manner in which the network pro2 vider submits prescriptions to retail pharmacies. 

3 ‘‘(2) Nothing in this section shall be construed to af4 fect the process of the Department for filling and paying 

5 for prescription medications. 

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

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

9 Services or other quality of care standards, as determined 

10 by the Secretary. 

11 ‘‘(k) CAPACITY AND COMMERCIAL MARKET ASSESS12 MENTS.—(1) On a periodic basis, but not less often than 

13 once every three years, the Secretary shall conduct an as14 sessment of the capacity of each Veterans Integrated Serv15 ice Network and medical facility of the Department to fur16 nish care or services under this chapter. Each such assess17 ment shall— 

18 ‘‘(A) identify gaps in furnishing such care or 

19 services at such Veterans Integrated Service Net20 work or medical facility; 

21 ‘‘(B) identify how such gaps can be filled by— 

22 ‘‘(i) entering into contracts or agreements 

23 with network providers under this section or 

24 with entities under other provisions of law; 


ethrower on DSK3G9T082PROD with BILLS
25 

•HR 4242 IH

1 ‘‘(ii) making changes in the way such care 

2 and services are furnished at such Veterans In3 tegrated Service Network or medical facility, in4 cluding but not limited to— 

5 ‘‘(I) extending hours of operation; 

6 ‘‘(II) adding personnel; or 

7 ‘‘(III) expanding space through con8 struction, leasing, or sharing of health care 

9 facilities; and 

10 ‘‘(iii) the building or realignment of De11 partment resources or personnel; 

12 ‘‘(C) forecast, based on future projections and 

13 historical trends, both the short- and long-term de14 mand in furnishing care or services at such Veterans 

15 Integrated Service Network or medical facility and 

16 assess how such demand affects the needs to use 

17 such network providers; 

18 ‘‘(D) include a commercial health care market 

19 assessment of designated catchment areas in the 

20 United States conducted by a nongovernmental enti21 ty; and 

22 ‘‘(E) consider the unique ability of the Federal 

23 Government to retain a presence in an area other24 wise devoid of commercial health care providers or 

25 from which such providers are at a risk of leaving. 


ethrower on DSK3G9T082PROD with BILLS
26 

•HR 4242 IH

1 ‘‘(2) The Secretary shall submit each assessment 

2 under paragraph (1) to the Committees on Veterans’ Af3 fairs of the House of Representatives and the Senate and 

4 shall make each such assessment publicly available. 

5 ‘‘(l) ALLOCATION OF FUNDS.—The Secretary shall 

6 develop a plan for the allocation of funds in the Medical 

7 Community Care account. 

8 ‘‘(m) REPORTS ON RATES.—Not later than Decem9 ber 31, 2019, and annually thereafter during each of the 

10 subsequent three years, the Secretary shall submit to the 

11 Committees on Veterans’ Affairs of the House of Rep12 resentatives and the Senate a report detailing, for the fis13 cal year preceding the fiscal year during which the report 

14 is submitted, the rates paid by the Secretary for hospital 

15 care, medical services, or extended care services under this 

16 section that, pursuant to subsection (d)(3), are more than 

17 the rates described in subsection (d)(2)(B) for the same 

18 care or services. 

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

20 ‘‘(1) The term ‘clean claim’ means a claim sub21 mitted— 

22 ‘‘(A) to the covered payer by a covered 

23 claimant for purposes of payment by the cov24 ered payer of expenses for hospital care or med25 ical services furnished under this section; 


ethrower on DSK3G9T082PROD with BILLS
27 

•HR 4242 IH

1 ‘‘(B) that contains substantially all of the 

2 required elements necessary for accurate adju3 dication, without requiring additional informa4 tion from the network provider; and 

5 ‘‘(C) in such a nationally recognized for6 mat as may be prescribed by the Secretary for 

7 purposes of paying claims for hospital care or 

8 medical services furnished under this section. 

9 ‘‘(2) The term ‘covered claimant’ means— 

10 ‘‘(A) a network provider that submits a 

11 claim to the Secretary for purposes of payment 

12 by the Secretary of expenses for hospital care 

13 or medical services furnished under this section; 

14 or 

15 ‘‘(B) a regional network operated by a con16 tractor pursuant to subsection (a)(4)(B) that 

17 submits a claim to the Secretary for purposes 

18 of reimbursement for a payment made by the 

19 contractor to a network provider for hospital 

20 care or medical services furnished under this 

21 section. 

22 ‘‘(3) The term ‘covered payer’ means— 

23 ‘‘(A) a regional network operated by a con24 tractor pursuant to subsection (a)(4)(B) with 

25 respect to a claim made by a network provider 


ethrower on DSK3G9T082PROD with BILLS
28 

•HR 4242 IH

1 to the contractor for purposes of payment by 

2 the contractor of expenses for hospital care or 

3 medical services furnished under this section; or 

4 ‘‘(B) the Secretary with respect to— 

5 ‘‘(i) a claim made by a network pro6 vider to the Secretary for purposes of pay7 ment by the Secretary of expenses for hos8 pital care or medical services furnished 

9 under this section; and 

10 ‘‘(ii) a claim made by a regional net11 work operated by a contractor pursuant to 

12 subsection (a)(4)(B) for purposes of reim13 bursement for a payment described by sub14 paragraph (A). 

15 ‘‘(4) The term ‘eligible veteran’ means a vet16 eran who— 

17 ‘‘(A) is enrolled in the patient enrollment 

18 system of the Department established and oper19 ated under section 1705(a) of this title; and 

20 ‘‘(B) has— 

21 ‘‘(i) been furnished hospital care or 

22 medical services at or through a Depart23 ment facility on at least one occasion dur24 ing the two-year period preceding the date 

25 of the determination of eligibility; or 


ethrower on DSK3G9T082PROD with BILLS
29 

•HR 4242 IH

1 ‘‘(ii) requested a first-time appoint2 ment for hospital care or medical services 

3 at a Department facility. 

4 ‘‘(5) The term ‘fraudulent claim’ means a claim 

5 by a network provider for reimbursement under this 

6 section that includes an intentional and deliberate 

7 misrepresentation of a material fact or facts that is 

8 intended to induce the Secretary to pay an amount 

9 that was not legally owed to the provider.’’. 

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

12 amended by inserting after the item relating to sec13 tion 1703 the following new item: 

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

14 (b) CONFORMING AMENDMENTS.—The Veterans Ac15 cess, Choice, and Accountability Act of 2014 (Public Law 

16 113–146) is amended— 

17 (1) in section 101(p)(1) (38 U.S.C. 1701 note), 

18 by inserting before the period at the end the fol19 lowing: ‘‘or the date on which the Secretary certifies 

20 to the Committees on Veterans’ Affairs of the House 

21 of Representatives and the Senate that the Secretary 

22 is fully implementing section 1703A of title 38, 

23 United States Code, whichever occurs first’’; and 


ethrower on DSK3G9T082PROD with BILLS
30 

•HR 4242 IH

1 (2) in section 208(1), by striking ‘‘section 101’’ 

2 and inserting ‘‘section 1703A of title 38, United 

3 States Code’’. 

4 (c) DEFINITIONS.—Section 1701 of title 38, United 

5 States Code, is amended by adding at the end the fol6 lowing new paragraphs: 

7 ‘‘(11) The term ‘network provider’ means any 

8 of the following health care providers that have en9 tered into a contract or agreement under which the 

10 provider agrees to furnish care and services to eligi11 ble veterans under section 1703A of this title: 

12 ‘‘(A) Any health care provider or supplier 

13 that is participating in the Medicare Program 

14 under title XVIII of the Social Security Act (42 

15 U.S.C. 1395 et seq.), including any physician 

16 furnishing services under such program. 

17 ‘‘(B) Any provider of items and services re18 ceiving payment under a State plan under title 

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

20 a waiver of such a plan. 

21 ‘‘(C) Any Federally-qualified health center 

22 (as defined in section 1905(l)(2)(B) of the So23 cial Security Act (42 U.S.C. 1396d(l)(2)(B))). 

24 ‘‘(D) The Department of Defense. 

25 ‘‘(E) The Indian Health Service. 


ethrower on DSK3G9T082PROD with BILLS
31 

•HR 4242 IH

1 ‘‘(F) Any health care provider that is an 

2 academic affiliate of the Department. 

3 ‘‘(G) Any health care provider not other4 wise covered under any of subparagraphs (A) 

5 through (F) that meets criteria established by 

6 the Secretary for purposes of such section. 

7 ‘‘(12) The term ‘VA Care in the Community 

8 Program’ means the program under which the Sec9 retary furnishes hospital care or medical services to 

10 veterans through network providers pursuant to sec11 tion 1703A of this title.’’. 

12 (d) TRANSITION OF PROVISION OF CARE.—This Act, 

13 and the amendments made by this Act, may not be con14 strued to affect the obligations of the Secretary of Vet15 erans Affairs under contracts and agreements for the pro16 vision of hospital care, medical services, and extended care 

17 services entered into before the date of the enactment of 

18 this Act at the terms and rates contained in such contracts 

19 and agreements. 

20 SEC. 103. VETERANS CARE AGREEMENTS. 

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

22 38, United States Code, is further amended by inserting 

23 after section 1703A, as added by section 102, the fol24 lowing new section: 


ethrower on DSK3G9T082PROD with BILLS
32 

•HR 4242 IH

1 ‘‘§ 1703B. Veterans Care Agreements with non-net2 work providers 

3 ‘‘(a) VETERANS CARE AGREEMENTS.—(1) In addi4 tion to furnishing hospital care, medical services, or ex5 tended care services under this chapter at facilities of the 

6 Department or under contracts or agreements entered into 

7 pursuant to section 1703A of this title or any other provi8 sion of law other than this section, the Secretary may fur9 nish such care and services to eligible veterans through 

10 the use of agreements, to be known as ‘Veterans Care 

11 Agreements’, entered into under this section by the Sec12 retary with eligible non-network providers. 

13 ‘‘(2) The Secretary may enter into a Veterans Care 

14 Agreement under this section with an eligible non-network 

15 provider if the Secretary determines that— 

16 ‘‘(A) the provision of the hospital care, medical 

17 services, or extended care services at a Department 

18 facility is impracticable or inadvisable because of the 

19 medical condition of the veteran, the travel involved, 

20 or the nature of the care or services required, or a 

21 combination of such factors; and 

22 ‘‘(B) such care or services are not available to 

23 be furnished by a non-Department health care pro24 vider under a contract or agreement entered into 

25 pursuant to a provision of law other than this sec26 tion. 


ethrower on DSK3G9T082PROD with BILLS
33 

•HR 4242 IH

1 ‘‘(3)(A) In accordance with subparagraphs (C) and 

2 (D), the Secretary shall review each Veterans Care Agree3 ment with a non-network provider to determine whether 

4 it is practical or advisable to, instead of carrying out such 

5 agreement— 

6 ‘‘(i) provide at a Department facility the hos7 pital care, medical services, or extended care services 

8 covered by such agreement; or 

9 ‘‘(ii) enter into an agreement with the provider 

10 under section 1703A of this title to provide such 

11 care or services. 

12 ‘‘(B) If the Secretary determines pursuant to a re13 view of a Veterans Care Agreement under subparagraph 

14 (A) that it is practical or advisable to provide hospital 

15 care, medical services, or extended care services at a De16 partment facility, or enter into an agreement under sec17 tion 1703A of this title to provide such care or services, 

18 as the case may be, the Secretary— 

19 ‘‘(i) may not renew the Veterans Care Agree20 ment; and 

21 ‘‘(ii) shall take such actions as are necessary to 

22 implement such determination. 

23 ‘‘(C) This paragraph shall apply with respect to Vet24 erans Care Agreements entered into with a non-network 


ethrower on DSK3G9T082PROD with BILLS
34 

•HR 4242 IH

1 provider whose gross annual revenue, as determined under 

2 subsection (b)(1), exceeds— 

3 ‘‘(i) $3,000,000, in the case of a provider that 

4 furnishes homemaker or home health aide services; 

5 or 

6 ‘‘(ii) $1,000,000, in the case of any other pro7 vider. 

8 ‘‘(D) The Secretary shall conduct each review of a 

9 Veterans Care Agreement under subparagraph (A) as fol10 lows: 

11 ‘‘(i) Once during the 18-month period beginning 

12 on the date that is six months after date on which 

13 the agreement is entered into. 

14 ‘‘(ii) Not less than once during each four-year 

15 period beginning on the date on which the review 

16 under subparagraph (A) is conducted. 

17 ‘‘(b) ELIGIBLE NON-NETWORK PROVIDERS.—A pro18 vider of hospital care, medical services, or extended care 

19 services is eligible to enter into a Veterans Care Agree20 ment under this section if the Secretary determines that 

21 the provider meets the following criteria: 

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

23 under contracts or agreements entered into with the 

24 Secretary in the year preceding the year in which 


ethrower on DSK3G9T082PROD with BILLS
35 

•HR 4242 IH

1 the provider enters into the Veterans Care Agree2 ment does not exceed— 

3 ‘‘(A) $5,000,000 (as adjusted in a manner 

4 similar to amounts adjusted pursuant to section 

5 5312 of this title), in the case of a provider 

6 that furnishes homemaker or home health aide 

7 services; or 

8 ‘‘(B) $2,000,000 (as so adjusted), in the 

9 case of any other provider. 

10 ‘‘(2) The provider is not a network provider and 

11 does not otherwise provide hospital care, medical 

12 services, or extended care services to patients pursu13 ant to a contract entered into with the Department. 

14 ‘‘(3) The provider is— 

15 ‘‘(A) a provider of services that has en16 rolled and entered into a provider agreement 

17 under section 1866(a) of the Social Security 

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

19 ‘‘(B) a physician or supplier that has en20 rolled and entered into a participation agree21 ment under section 1842(h) of such Act (42 

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

23 ‘‘(C) a provider of items and services re24 ceiving payment under a State plan under title 


ethrower on DSK3G9T082PROD with BILLS
36 

•HR 4242 IH

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

2 a waiver of such a plan; 

3 ‘‘(D) an Aging and Disability Resource 

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

5 agency (as defined in section 102 of the Older 

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

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

8 defined in section 702 of the Rehabilitation Act 

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

10 ‘‘(4) The provider is certified pursuant to the 

11 process established under subsection (c)(1). 

12 ‘‘(5) Any additional criteria determined appro13 priate by the Secretary. 

14 ‘‘(c) PROVIDER CERTIFICATION.—(1) The Secretary 

15 shall establish a process for the certification of eligible 

16 providers to enter into Veterans Care Agreements under 

17 this section that shall, at a minimum, set forth the fol18 lowing: 

19 ‘‘(A) Procedures for the submission of applica20 tions for certification and deadlines for actions taken 

21 by the Secretary with respect to such applications. 

22 ‘‘(B) Standards and procedures for the ap23 proval and denial of certifications and the revocation 

24 of certifications. 


ethrower on DSK3G9T082PROD with BILLS
37 

•HR 4242 IH

1 ‘‘(C) Procedures for assessing eligible providers 

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

3 providers similar to the level of screening under sec4 tion 1866(j)(2)(B) of the Social Security Act (42 

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

6 under section 9.104 of title 48, Code of Federal 

7 Regulations, or any successor regulation. 

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

9 certification if the Secretary determines that the 

10 otherwise eligible provider is— 

11 ‘‘(i) excluded from participation in a Fed12 eral health care program (as defined in section 

13 1128B(f) of the Social Security Act (42 U.S.C. 

14 1320a–7b(f))) under section 1128 or 1128A of 

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

16 and 1320a–7a); or 

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

18 the list maintained in the System for Award 

19 Management, or any successor system. 

20 ‘‘(E) Procedures by which a provider whose cer21 tification is denied or revoked under the procedures 

22 established under this subsection will be identified as 

23 an excluded source on the list maintained in the Sys24 tem for Award Management, or successor system, if 


ethrower on DSK3G9T082PROD with BILLS
38 

•HR 4242 IH

1 the Secretary determines that such exclusion is ap2 propriate. 

3 ‘‘(2) To the extent practicable, the Secretary shall es4 tablish the procedures under paragraph (1) in a manner 

5 that takes into account any certification process adminis6 tered by another department or agency of the Federal 

7 Government that an eligible provider has completed by 

8 reason of being a provider described in any of subpara9 graphs (A) through (E) of subsection (b)(4). 

10 ‘‘(d) TERMS OF AGREEMENTS.—Subsections (d), (e), 

11 (f), and (g) of section 1703A of this title shall apply with 

12 respect to a Veterans Care Agreement in the same manner 

13 such subsections apply to contracts and agreements en14 tered into under such section. 

15 ‘‘(e) EXCLUSION OF CERTAIN FEDERAL CON16 TRACTING PROVISIONS.—(1) Notwithstanding any other 

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

18 Care Agreement using procedures other than competitive 

19 procedures. 

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

21 unless otherwise provided in this section, an eligible non22 network provider that enters into a Veterans Care Agree23 ment under this section is not subject to, in the carrying 

24 out of the agreement, any provision of law that providers 

25 of services and suppliers under the original Medicare feeVerDate Sep 11 2014 21:31 Nov 06, 2017 Jkt 079200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H4242.IH H4242

ethrower on DSK3G9T082PROD with BILLS
39 

•HR 4242 IH

1 for-service program under parts A and B of title XVIII 

2 of the Social Security Act (42 U.S.C. 1395 et seq.) or the 

3 Medicaid program under title XIX of such Act (42 U.S.C. 

4 1396 et seq.) are not subject to. 

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

6 subparagraph (A), an eligible non-network provider shall 

7 be subject to the following provisions of law: 

8 ‘‘(i) Any applicable law regarding integrity, eth9 ics, or fraud, or that subject a person to civil or 

10 criminal penalties. 

11 ‘‘(ii) Section 1352 of title 31, except for the fil12 ing requirements under subsection (b) of such sec13 tion. 

14 ‘‘(iii) Section 4705 or 4712 of title 41, and any 

15 other applicable law regarding the protection of 

16 whistleblowers. 

17 ‘‘(iv) Section 4706(d) of title 41. 

18 ‘‘(v) Title VII of the Civil Rights Act of 1964 

19 (42 U.S.C. 2000e et seq.) to the same extent as 

20 such title applies with respect to the eligible non-net21 work provider in providing care or services through 

22 an agreement or arrangement other than under a 

23 Veterans Care Agreement. 

24 ‘‘(f) TERMINATION OF A VETERANS CARE AGREE25 MENT.—(1) An eligible non-network provider may termiVerDate Sep 11 2014 21:31 Nov 06, 2017 Jkt 079200 PO 00000 Frm 00039 Fmt 6652 Sfmt 6201 E:\BILLS\H4242.IH H4242

ethrower on DSK3G9T082PROD with BILLS
40 

•HR 4242 IH

1 nate a Veterans Care Agreement with the Secretary under 

2 this section at such time and upon such notice to the Sec3 retary as the Secretary may specify for purposes of this 

4 section. 

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

6 Agreement with an eligible non-network provider under 

7 this section at such time and upon such notice to the pro8 vider as the Secretary may specify for the purposes of this 

9 section, if the Secretary determines necessary. 

10 ‘‘(g) DISPUTES.—(1) The Secretary shall establish 

11 administrative procedures for providers with which the 

12 Secretary has entered into a Veterans Care Agreement to 

13 present any dispute arising under or related to the agree14 ment. 

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

16 under chapter 71 of title 41 with respect to a dispute aris17 ing under a Veterans Care Agreement under this section, 

18 a provider must first exhaust the administrative proce19 dures established by the Secretary under paragraph (1). 

20 ‘‘(h) AUTHORITY TO PAY FOR OTHER AUTHORIZED

21 SERVICES.—(1) If, in the course of an episode of care for 

22 which hospital care, medical services, or extended care 

23 services are furnished to an eligible veteran pursuant to 

24 a Veterans Care Agreement, any part of such care or serv25 ices is furnished by a medical provider who is not an eligiVerDate Sep 11 2014 21:31 Nov 06, 2017 Jkt 079200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\H4242.IH H4242

ethrower on DSK3G9T082PROD with BILLS
41 

•HR 4242 IH

1 ble non-network provider or a network provider, the Sec2 retary may compensate such provider for furnishing such 

3 care or services. 

4 ‘‘(2) The Secretary shall make reasonable efforts to 

5 enter into a Veterans Care Agreement with any provider 

6 who is compensated pursuant to paragraph (1). 

7 ‘‘(i) ANNUAL REPORTS.—(1) Not later than Decem8 ber 31 of the year following the fiscal year in which the 

9 Secretary first enters into a Veterans Care Agreement 

10 under this section, and each year thereafter, the Secretary 

11 shall submit to the appropriate congressional committees 

12 an annual report that includes a list of all Veterans Care 

13 Agreements entered into as of the date of the report. 

14 ‘‘(2) The requirement to submit a report under para15 graph (1) shall terminate on the date that is five years 

16 after the date of the enactment of this section. 

17 ‘‘(j) QUALITY OF CARE.—In carrying out this sec18 tion, the Secretary shall use the quality of care standards 

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

20 Services or other quality of care standards, as determined 

21 by the Secretary. 

22 ‘‘(k) DELEGATION.—The Secretary may delegate the 

23 authority to enter into or terminate a Veterans Care 

24 Agreement to an official of the Department at a level not 


ethrower on DSK3G9T082PROD with BILLS
42 

•HR 4242 IH

1 below the Director of a Veterans Integrated Service Net2 work or the Director of a Network Contracting Office. 

3 ‘‘(l) DEFINITIONS.—In this section: 

4 ‘‘(1) The term ‘appropriate congressional com5 mittees’ means— 

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

7 of the House of Representatives and the Sen8 ate; and 

9 ‘‘(B) the Committees on Appropriations of 

10 the House of Representatives and the Senate. 

11 ‘‘(2) The term ‘eligible veteran’ has the mean12 ing given such term in section 1703A(m) of this 

13 title.’’. 

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

15 at the beginning of such chapter is amended by inserting 

16 after the item relating to section 1703A, as added by sec17 tion 102, the following new item: 

‘‘1703B. Veterans Care Agreements with non-network providers.’’. 

18 SEC. 104. MODIFICATION OF AUTHORITY TO ENTER INTO 

19 AGREEMENTS WITH STATE HOMES TO PRO20 VIDE NURSING HOME CARE. 

21 (a) USE OF AGREEMENTS.— 

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

23 1745(a) of title 38, United States Code, is amended, 

24 in the matter preceding subparagraph (A), by strik25 ing ‘‘a contract (or agreement under section 


ethrower on DSK3G9T082PROD with BILLS
43 

•HR 4242 IH

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) TREATMENT OF CERTAIN LAWS.—Such section 

7 is amended by adding at the end the following new para8 graph: 

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 in regulations pre15 scribed pursuant to this section, a State home that enters 

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

17 the carrying out of the agreement, any law to which pro18 viders of services and suppliers are not subject 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. 


ethrower on DSK3G9T082PROD with BILLS
44 

•HR 4242 IH

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

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

3 home that enters into an agreement under this section to 

4 the same extent as such title applies with respect to the 

5 State home in providing care or services through an agree6 ment or arrangement other than under this section.’’. 

7 (c) EFFECTIVE DATE.— 

8 (1) IN GENERAL.—The amendments made by 

9 this section shall apply to agreements entered into 

10 under section 1745 of such title on and after the 

11 date on which the regulations prescribed by the Sec12 retary of Veterans Affairs to implement such amend13 ments take effect. 

14 (2) PUBLICATION.—The Secretary shall publish 

15 the date described in paragraph (1) in the Federal 

16 Register not later than 30 days before such date. 

17 SEC. 105. DEPARTMENT OF VETERANS AFFAIRS ELEC18 TRONIC INTERFACE FOR PROCESSING OF 

19 MEDICAL CLAIMS. 

20 (a) ELECTRONIC INTERFACE.—Not later than the 

21 implementation date specified in section 108(a), the Chief 

22 Information Officer of the Department of Veterans Affairs 

23 shall ensure that the information technology system used 

24 by the Department to receive, process, and pay claims 

25 under the VA Care in the Community Program estabVerDate Sep 11 2014 21:31 Nov 06, 2017 Jkt 079200 PO 00000 Frm 00044 Fmt 6652 Sfmt 6201 E:\BILLS\H4242.IH H4242

ethrower on DSK3G9T082PROD with BILLS
45 

•HR 4242 IH

1 lished in section 1703A of title 38, United States Code, 

2 as added by section 102, and under Veterans Care Agree3 ments established in section 1703B of such title, as added 

4 by section 103, includes the following: 

5 (1) A function through which a covered non-De6 partment health care provider may submit all re7 quired data and supporting information required for 

8 claims reimbursement through electronic data inter9 changes. 

10 (2) An ability to automatically adjudicate 

11 claims. 

12 (3) A centralized claims database that is acces13 sible nationwide. 

14 (4) Integration with the relevant eligibility and 

15 authorization information technology systems of the 

16 Department. 

17 (5) Ability for a covered non-Department health 

18 care provider to ascertain the status of a pending 

19 claim submitted by the provider, receive information 

20 regarding missing documentation or discrepancies 

21 that may impede claim processing timelines or result 

22 in rejection, and receive notification when such claim 

23 is accepted for reimbursement or rejected. 

24 (6) A claim review system similar to that used 

25 by the Centers for Medicare & Medicaid Services, as 


ethrower on DSK3G9T082PROD with BILLS
46 

•HR 4242 IH

1 of the date of the enactment of this Act, to deter2 mine the appropriateness and accuracy of payments 

3 to providers and to ensure program integrity and 

4 oversight. 

5 (b) SECURITY AND PRIVACY.—The Chief Information 

6 Officer shall also ensure that the information technology 

7 system covered under subsection (a) meets the following 

8 criteria: 

9 (1) Such system shall be developed and imple10 mented in compliance with all applicable laws, regu11 lations and Federal Government standards regarding 

12 information security, privacy, and accessibility. 

13 (2) Such system shall provide for the elicitation, 

14 analysis, and prioritization of functional and non15 functional information security and privacy require16 ments for such system, including security and pri17 vacy services and architectural requirements relating 

18 to security and privacy based on a thorough risk as19 sessment of all reasonably anticipated cyber and 

20 noncyber threats to the security and privacy of elec21 tronic protected health information made available 

22 through such interface. 

23 (3) Such system shall provide for the elicitation, 

24 analysis, and prioritization of secure development re25 quirements relating to such system. 


ethrower on DSK3G9T082PROD with BILLS
47 

•HR 4242 IH

1 (4) Such system shall provide assurance that 

2 the prioritized information security and privacy re3 quirements of such system— 

4 (A) are correctly implemented in the de5 sign and implementation of such system 

6 through the systems development lifecycle; and 

7 (B) satisfy the information objectives of 

8 such system relating to security and privacy 

9 throughout the systems development lifecycle. 

10 (c) CONTRACT AUTHORITY.—The Chief Information 

11 Officer may enter into a contract for purposes of carrying 

12 out this section. 

13 (d) DEFINITIONS.—In this section: 

14 (1) The term ‘‘electronic protected health infor15 mation’’ has the meaning given that term in section 

16 160.103 of title 45, Code of Federal Regulations, as 

17 in effect on the date of the enactment of this Act. 

18 (2) The term ‘‘covered non-Department health 

19 care provider’’ means— 

20 (A) a network provider (as defined by sec21 tion 1701(11) of title 38, United States Code, 

22 as added by section 102); 

23 (B) a non-network provider with which the 

24 Secretary has entered into a Veterans Care 


ethrower on DSK3G9T082PROD with BILLS
48 

•HR 4242 IH

1 Agreement under section 1703B of such title, 

2 as added by section 103; or 

3 (C) any other non-Department eligible pro4 vider or non-Department health care provider 

5 that furnishes hospital care or medical services 

6 pursuant to chapter 17 of such title. 

7 (3) The term ‘‘secure development require8 ments’’ means, with respect to the information tech9 nology system established under subsection (a), ac10 tivities that are required to be completed during the 

11 system development lifecycle of such interface, such 

12 as secure coding principles and test methodologies. 

13 (4) The term ‘‘VA Care in the Community Pro14 gram’’ has the meaning given that term in section 

15 1701(12) of title 38, United States Code, as added 

16 by section 102. 

17 SEC. 106. FUNDING FOR VA CARE IN THE COMMUNITY PRO18 GRAM. 

19 (a) IN GENERAL.—All amounts required to carry out 

20 the VA Care in the Community Program and Veterans 

21 Care Agreements under section 1703B of title 38, United 

22 States Code, shall be derived from the Veterans Health 

23 Administration, Medical Community Care account. 

24 (b) TRANSFER OF AMOUNTS.— 


ethrower on DSK3G9T082PROD with BILLS
49 

•HR 4242 IH

1 (1) IN GENERAL.—Any unobligated amounts in 

2 the Veterans Choice Fund under section 802 of the 

3 Veterans Access, Choice, and Accountability Act of 

4 2014 (Public Law 113–146; 38 U.S.C. 1701 note) 

5 shall be transferred to the Veterans Health Adminis6 tration, Medical Community Care account on the 

7 later of the following dates: 

8 (A) The date that is one year after the 

9 date of the enactment of this Act. 

10 (B) The date on which the Secretary of 

11 Veterans Affairs submits to the Committees on 

12 Veterans’ Affairs of the Senate and the House 

13 of Representatives the certification required by 

14 section 107(c). 

15 (2) CONFORMING REPEAL.— 

16 (A) IN GENERAL.—Effective immediately 

17 following the transfer of amounts under para18 graph (1), section 802 of the Veterans Access, 

19 Choice, and Accountability Act of 2014 (Public 

20 Law 113–146; 38 U.S.C. 1701 note) is re21 pealed. 

22 (B) CONFORMING AMENDMENT.—Section 

23 4003 of the Surface Transportation and Vet24 erans Health Care Choice Improvement Act of 

25 2015 (Public Law 114–41; 38 U.S.C. 1701 


ethrower on DSK3G9T082PROD with BILLS
50 

•HR 4242 IH

1 note) is amended by striking ‘‘for non-Depart2 ment provider programs (as defined in section 

3 2(d))’’ and all that follows through ‘‘1802)’’ 

4 and inserting the following: ‘‘for the VA Care in 

5 the Community Program (as defined in section 

6 1701(12) of title 38, United States Code) and 

7 Veterans Care Agreements under section 

8 1703B of title 38, United States Code’’. 

9 (c) VA CARE IN THE COMMUNITY PROGRAM DE10 FINED.—In this section, the term ‘‘VA Care in the Com11 munity Program’’ has the meaning given that term in sec12 tion 1701(12) of title 38, United States Code, as added 

13 by section 102. 

14 SEC. 107. TERMINATION OF CERTAIN PROVISIONS AUTHOR15 IZING MEDICAL CARE TO VETERANS 

16 THROUGH NON-DEPARTMENT OF VETERANS 

17 AFFAIRS PROVIDERS. 

18 (a) TERMINATION OF AUTHORITY TO CONTRACT FOR

19 CARE IN NON-DEPARTMENT FACILITIES.— 

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

21 United States Code, is amended by adding at the 

22 end the following new subsection: 

23 ‘‘(e) The authority of the Secretary to carry out this 

24 section terminates on the date on which the Secretary cer25 tifies to the Committees on Veterans’ Affairs of the House 


ethrower on DSK3G9T082PROD with BILLS
51 

•HR 4242 IH

1 of Representatives and the Senate that the Secretary is 

2 fully implementing section 1703A of this title.’’. 

3 (2) CONFORMING AMENDMENTS.— 

4 (A) DENTAL CARE.—Section 1712(a) of 

5 such title is amended— 

6 (i) in paragraph (3), by striking 

7 ‘‘under clause (1), (2), or (5) of section 

8 1703(a) of this title’’ and inserting ‘‘under 

9 the VA Care in the Community Program’’; 

10 and 

11 (ii) in paragraph (4)(A), in the first 

12 sentence— 

13 (I) by striking ‘‘and section 1703 

14 of this title’’ and inserting ‘‘and the 

15 VA Care in the Community Program 

16 (with respect to such a year beginning 

17 on or after the date on which the Sec18 retary commences implementation of 

19 the VA Care in the Community Pro20 gram)’’; and 

21 (II) by striking ‘‘in section 1703 

22 of this title’’ and inserting ‘‘under the 

23 VA Care in the Community Pro24 gram’’. 


ethrower on DSK3G9T082PROD with BILLS
52 

•HR 4242 IH

1 (B) READJUSTMENT COUNSELING.—Sec2 tion 1712A(e)(1) of such title is amended by 

3 striking ‘‘(under sections 1703(a)(2) and 

4 1710(a)(1)(B) of this title)’’ and inserting 

5 ‘‘(under the VA Care in the Community Pro6 gram)’’. 

7 (C) DEATH IN DEPARTMENT FACILITY.— 

8 Section 2303(a)(2)(B)(i) of such title is amend9 ed by striking ‘‘in accordance with section 1703 

10 of this title’’ and inserting ‘‘under the VA Care 

11 in the Community Program’’. 

12 (D) MEDICARE PROVIDER AGREEMENTS.— 

13 Section 1866(a)(1)(L) of the Social Security 

14 Act (42 U.S.C. 1395cc(a)(1)(L)) is amended— 

15 (i) by striking ‘‘under section 1703 of 

16 title 38’’ and inserting ‘‘under the VA 

17 Care in the Community Program (as de18 fined in section 1701(12) of title 38, 

19 United States Code)’’; and 

20 (ii) by striking ‘‘such section’’ and in21 serting ‘‘such program’’. 

22 (b) REPEAL OF AUTHORITY TO CONTRACT FOR

23 SCARCE MEDICAL SPECIALISTS.— 

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

25 United States Code, is repealed. 


ethrower on DSK3G9T082PROD with BILLS
53 

•HR 4242 IH

1 (2) CLERICAL AMENDMENT.—The table of sec2 tions at the beginning of chapter 74 of such title is 

3 amended by striking the item relating to section 

4 7409. 

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

6 subsections (a) and (b) shall take effect on the date on 

7 which the Secretary certifies to the Committees on Vet8 erans’ Affairs of the House of Representatives and the 

9 Senate that the Secretary is fully implementing section 

10 1703A of title 38, United States Code, as added by section 

11 102. 

12 SEC. 108. IMPLEMENTATION AND TRANSITION. 

13 (a) IMPLEMENTATION.—The Secretary of Veterans 

14 Affairs shall commence the implementation of section 

15 1703A of title 38, United States Code, as added by section 

16 102, and section 1703B of such title, as added by section 

17 103, and shall make the transfer under section 106(b), 

18 by not later than one year after the date of the enactment 

19 of this Act. The Secretary shall prescribe interim final reg20 ulations to implement such sections and publish such reg21 ulations in the Federal Register. 

22 (b) TRAINING.—Before commencing the implementa23 tion of sections 1703A and 1703B of title 38, United 

24 States Code, as added by sections 102 and 103, respec25 tively, the Secretary of Veterans Affairs shall— 


ethrower on DSK3G9T082PROD with BILLS
54 

•HR 4242 IH

1 (1) certify to the Committees on Veterans’ Af2 fairs of the House of Representatives and the Senate 

3 that— 

4 (A) each network provider (as defined by 

5 section 1701(11) of title 38, United States 

6 Code) and eligible non-network provider that 

7 furnishes care or services under such section 

8 1703A or section 1703B is trained to furnish 

9 such care or services under such sections; and 

10 (B) each employee of the Department that 

11 refers, authorizes, or coordinates such care or 

12 services is trained to carry out such sections; 

13 and 

14 (2) establish standard, written guidance for net15 work providers, non-Department health care pro16 viders, and any non-Department administrative enti17 ties acting on behalf of such providers, with respect 

18 to the policies and procedures for furnishing care or 

19 services under such sections. 


ethrower on DSK3G9T082PROD with BILLS
55 

•HR 4242 IH

1 TITLE II—OTHER 

2 ADMINISTRATIVE MATTERS 

3 SEC. 201. REIMBURSEMENT FOR EMERGENCY AMBULANCE 

4 SERVICES. 

5 (a) IN GENERAL.—Section 1725(c) of title 38, 

6 United States Code, is amended by adding at the end the 

7 following new paragraph: 

8 ‘‘(5) In delineating the circumstances under which re9 imbursement may be made under this section for ambu10 lance services for an individual, the Secretary shall treat 

11 such services as emergency services for which reimburse12 ment may be made under this section if the Secretary de13 termines that— 

14 ‘‘(A) the request for ambulance services was 

15 made as a result of the sudden onset of a medical 

16 condition of such a nature that a prudent layperson 

17 who possesses an average knowledge of health and 

18 medicine— 

19 ‘‘(i) would have reasonably expected that a 

20 delay in seeking immediate medical attention 

21 would have been hazardous to the life or health 

22 of the individual; or 

23 ‘‘(ii) could reasonably expect the absence 

24 of immediate medical attention to result in 

25 placing the health of the individual in serious 


ethrower on DSK3G9T082PROD with BILLS
56 

•HR 4242 IH

1 jeopardy, the serious impairment of bodily func2 tions, or the serious dysfunction of any bodily 

3 organ or part; and 

4 ‘‘(B) the individual is transported to the most 

5 appropriate medical facility capable of treating such 

6 medical condition.’’. 

7 (b) EFFECTIVE DATE.—The amendment made by 

8 subsection (a) shall take effect on the date of the enact9 ment of this Act and shall apply with respect to ambulance 

10 services provided on or after January 1, 2019. 

11 SEC. 202. IMPROVEMENT OF CARE COORDINATION FOR 

12 VETERANS THROUGH EXCHANGE OF CER13 TAIN MEDICAL RECORDS. 

14 Section 7332(b) of title 38, United States Code, is 

15 amended— 

16 (1) in paragraph (2), by adding at the end the 

17 following new subparagraphs: 

18 ‘‘(H) To a public or private health care 

19 provider in order to provide treatment or health 

20 care to a shared patient. 

21 ‘‘(I) To a third party in order to recover 

22 or collect reasonable charges for care furnished 

23 to a veteran for a non-service-connected dis24 ability pursuant to section 1729 of this title or 


ethrower on DSK3G9T082PROD with BILLS
57 

•HR 4242 IH

1 section 1 of Public Law 87–693 (42 U.S.C. 

2 2651).’’; and 

3 (2) by adding at the end the following new 

4 paragraph: 

5 ‘‘(4) Nothing in this section shall be construed to au6 thorize any provision of records in violation of relevant 

7 health record privacy laws, including the Health Insurance 

8 Portability and Accountability Act of 1996 (Public Law 

9 104–191).’’. 

10 SEC. 203. ELIMINATION OF COPAYMENT OFFSET. 

11 (a) IN GENERAL.—Section 1729(a) of title 38, 

12 United States Code, is amended by adding at the end the 

13 following new paragraph: 

14 ‘‘(4) Notwithstanding any other provision of 

15 law, any amount that the United States may collect 

16 or recover under this section shall not affect any co17 payment amount a veteran is otherwise obligated to 

18 pay under this chapter.’’. 

19 (b) EFFECTIVE DATE.—The amendment made by 

20 subsection (a) shall take effect on the date of the enact21 ment of this Act and apply with respect to a copayment 

22 obligation that arises on or after the date of the enactment 

23 of this Act. 


ethrower on DSK3G9T082PROD with BILLS
58 

•HR 4242 IH

1 SEC. 204. USE OF DEPARTMENT OF VETERANS AFFAIRS 

2 MEDICAL CARE COLLECTIONS FUND FOR 

3 CERTAIN IMPROVEMENTS IN COLLECTIONS. 

4 Section 1729A(c)(1)(B) of title 38, United States 

5 Code, is amended by inserting ‘‘(including with respect to 

6 automatic data processing or information technology im7 provements)’’ after ‘‘collection’’. 

8 SEC. 205. DEPARTMENT OF VETERANS AFFAIRS HEALTH 

9 CARE PRODUCTIVITY IMPROVEMENT. 

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

11 38, United States Code, is further amended by inserting 

12 after section 1705A the following new section: 

13 ‘‘§ 1705B. Management of health care: productivity 

14 ‘‘(a) RELATIVE VALUE UNIT TRACKING.—The Sec15 retary shall track relative value units for all Department 

16 providers. 

17 ‘‘(b) CLINICAL PROCEDURE CODING TRAINING.— 

18 The Secretary shall require all Department providers to 

19 attend training on clinical procedure coding. 

20 ‘‘(c) PERFORMANCE STANDARDS.—The Secretary 

21 shall establish for each Department facility— 

22 ‘‘(1) standardized performance standards based 

23 on nationally recognized relative value unit produc24 tion standards applicable to each specific profession 

25 in order to evaluate clinical productivity at the pro26 vider and facility level; 


ethrower on DSK3G9T082PROD with BILLS
59 

•HR 4242 IH

1 ‘‘(2) remediation plans to address low clinical 

2 productivity and clinical inefficiency; and 

3 ‘‘(3) an ongoing process to systematically re4 view the content, implementation, and outcome of 

5 the plans developed under paragraph (2). 

6 ‘‘(d) DEFINITIONS.—In this section: 

7 ‘‘(1) The term ‘Department provider’ means an 

8 employee of the Department whose primary respon9 sibilities include furnishing hospital care or medical 

10 services, including a physician, a dentist, an optom11 etrist, a podiatrist, a chiropractor, an advanced 

12 practice registered nurse, and a physician’s assistant 

13 acting as an independent provider. 

14 ‘‘(2) The term ‘relative value unit’ means a unit 

15 for measuring workload by determining the time, 

16 mental effort and judgment, technical skill, physical 

17 effort, and stress involved in delivering a proce18 dure.’’. 

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

20 at the beginning of such chapter is further amended by 

21 inserting after the item relating to section 1705A the fol22 lowing new item: 

‘‘1705B. Management of health care: productivity.’’. 

23 (c) REPORT.—Not later than one year after the date 

24 of the enactment of this Act, the Secretary shall submit 

25 to Congress a report on the implementation of section 


ethrower on DSK3G9T082PROD with BILLS
60 

•HR 4242 IH

1 1705B of title 38, United States Code, as added by sub2 section (a). Such report shall include, for each professional 

3 category of Department providers, the relative value unit 

4 of such category of providers at the national, Veterans In5 tegrated Service Network, and facility levels. 

6 SEC. 206. LICENSURE OF HEALTH CARE PROFESSIONALS 

7 OF THE DEPARTMENT OF VETERANS AF8 FAIRS PROVIDING TREATMENT VIA TELE9 MEDICINE. 

10 (a) IN GENERAL.—Chapter 17 of title 38, United 

11 States Code, is further amended by inserting after section 

12 1730A the following new section: 

13 ‘‘§ 1730B. Licensure of health care professionals pro14 viding treatment via telemedicine 

15 ‘‘(a) IN GENERAL.—Notwithstanding any provision 

16 of law regarding the licensure of health care professionals, 

17 a covered health care professional may practice the health 

18 care profession of the health care professional at any loca19 tion in any State, regardless of where the covered health 

20 care professional or the patient is located, if the covered 

21 health care professional is using telemedicine to provide 

22 treatment to an individual under this chapter. 

23 ‘‘(b) PROPERTY OF FEDERAL GOVERNMENT.—Sub24 section (a) shall apply to a covered health care professional 

25 providing treatment to a patient regardless of whether the 


ethrower on DSK3G9T082PROD with BILLS
61 

•HR 4242 IH

1 covered health care professional or patient is located in 

2 a facility owned by the Federal Government during such 

3 treatment. 

4 ‘‘(c) CONSTRUCTION.—Nothing in this section may 

5 be construed to remove, limit, or otherwise affect any obli6 gation of a covered health care professional under the Con7 trolled Substances Act (21 U.S.C. 801 et seq.). 

8 ‘‘(d) COVERED HEALTH CARE PROFESSIONAL DE9 FINED.—In this section, the term ‘covered health care pro10 fessional’ means a health care professional who— 

11 ‘‘(1) is an employee of the Department ap12 pointed under the authority under section 7306, 

13 7401, 7405, 7406, or 7408 of this title, or title 5; 

14 ‘‘(2) is authorized by the Secretary to provide 

15 health care under this chapter; 

16 ‘‘(3) is required to adhere to all quality stand17 ards relating to the provision of telemedicine in ac18 cordance with applicable policies of the Department; 

19 and 

20 ‘‘(4) has an active, current, full, and unre21 stricted license, registration, or certification in a 

22 State to practice the health care profession of the 

23 health care professional.’’. 

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

25 at the beginning of chapter 17 of such title is further 


ethrower on DSK3G9T082PROD with BILLS
62 

•HR 4242 IH

1 amended by inserting after the item relating to section 

2 1730A the following new item: 

‘‘1730B. Licensure of health care professionals providing treatment via telemedicine.’’. 

3 (c) REPORT ON TELEMEDICINE.— 

4 (1) IN GENERAL.—Not later than one year 

5 after the date of the enactment of this Act, the Sec6 retary of Veterans Affairs shall submit to the Com7 mittee on Veterans’ Affairs of the Senate and the 

8 Committee on Veterans’ Affairs of the House of 

9 Representatives a report on the effectiveness of the 

10 use of telemedicine by the Department of Veterans 

11 Affairs. 

12 (2) ELEMENTS.—The report required by para13 graph (1) shall include an assessment of the fol14 lowing: 

15 (A) The satisfaction of veterans with tele16 medicine furnished by the Department. 

17 (B) The satisfaction of health care pro18 viders in providing telemedicine furnished by 

19 the Department. 

20 (C) The effect of telemedicine furnished by 

21 the Department on the following: 

22 (i) The ability of veterans to access 

23 health care, whether from the Department 


ethrower on DSK3G9T082PROD with BILLS
63 

•HR 4242 IH

1 or from non-Department health care pro2 viders. 

3 (ii) The frequency of use by veterans 

4 of telemedicine. 

5 (iii) The productivity of health care 

6 providers. 

7 (iv) Wait times for an appointment 

8 for the receipt of health care from the De9 partment. 

10 (v) The reduction, if any, in the use 

11 by veterans of in-person services at De12 partment facilities and non-Department fa13 cilities. 

14 (D) The types of appointments for the re15 ceipt of telemedicine furnished by the Depart16 ment that were provided during the one-year 

17 period preceding the submittal of the report. 

18 (E) The number of appointments for the 

19 receipt of telemedicine furnished by the Depart20 ment that were requested during such period, 

21 disaggregated by Veterans Integrated Service 

22 Network. 

23 (F) Savings by the Department, if any, in24 cluding travel costs, of furnishing health care 


ethrower on DSK3G9T082PROD with BILLS
64 

•HR 4242 IH

1 through the use of telemedicine during such pe2 riod. 

Æ 


ethrower on DSK3G9T082PROD with BILLS