I 

115TH CONGRESS 

2D SESSION H. R. 4783 

To amend the Veterans Access, Choice, and Accountability Act of 2014 

to improve the scheduling of appointments, the accountability of third 

party administrators, and payment to providers under such Act, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 11, 2018 

Ms. ROSEN (for herself and Mr. JONES) introduced the following bill; which 

was referred to the Committee on Veterans’ Affairs 

A BILL 

To amend the Veterans Access, Choice, and Accountability 

Act of 2014 to improve the scheduling of appointments, 

the accountability of third party administrators, and payment to providers under such Act, 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 Deserve Bet5 ter Act’’. 


lotter on DSKBCFDHB2PROD with BILLS
2 

•HR 4783 IH

1 SEC. 2. PAYMENT TO PROVIDERS UNDER VETERANS 

2 CHOICE PROGRAM, SCHEDULING OF AP3 POINTMENTS, AND ACCOUNTABILITY OF 

4 THIRD PARTY ADMINISTRATORS UNDER 

5 SUCH PROGRAM. 

6 Section 101 of the Veterans Access, Choice, and Ac7 countability Act of 2014 (Public Law 113–146; 38 U.S.C. 

8 1701 note) is amended by adding at the end the following 

9 new subsections: 

10 ‘‘(u) PROMPT PAYMENT.— 

11 ‘‘(1) PAYMENT OF CLAIMS.— 

12 ‘‘(A) IN GENERAL.—Notwithstanding any 

13 other provision of this section or any other pro14 vision of law, the Secretary shall pay for hos15 pital care or medical services furnished by a 

16 health care entity or provider under this section 

17 within 45 calendar days upon receipt of a clean 

18 paper claim or 30 calendar days upon receipt of 

19 a clean electronic claim. 

20 ‘‘(B) DENIAL.—If a claim is denied, the 

21 Secretary shall, within 45 calendar days of de22 nial for a paper claim and 30 calendar days of 

23 denial for an electronic claim, notify the health 

24 care entity or provider of the reason for denying 

25 the claim and what, if any, additional informa26 tion is required to process the claim. 


lotter on DSKBCFDHB2PROD with BILLS
3 

•HR 4783 IH

1 ‘‘(C) ADDITIONAL INFORMATION.—Upon 

2 the receipt of additional information described 

3 in subparagraph (B) with respect to a denied 

4 claim, the Secretary shall ensure that the claim 

5 is paid, denied, or otherwise adjudicated within 

6 30 calendar days from the receipt of the re7 quested information. 

8 ‘‘(D) INVOICE BASIS.—This subsection 

9 shall only apply to payments made on an in10 voice basis and shall not apply to capitation or 

11 other forms of periodic payment. 

12 ‘‘(2) SUBMITTAL OF CLAIMS.—A health care 

13 entity or provider that furnishes hospital care or 

14 medical services under this section shall submit to 

15 the Secretary a claim for payment for furnishing the 

16 hospital care or medical services not later than 180 

17 days after the date on which the health care entity 

18 or provider furnished the hospital care or medical 

19 services. 

20 ‘‘(3) FRAUDULENT CLAIMS.— 

21 ‘‘(A) IN GENERAL.—Sections 3729 

22 through 3733 of title 31, United States Code, 

23 shall apply to fraudulent claims for payment 

24 submitted to the Secretary by a health care en25 tity or provider under this section. 


lotter on DSKBCFDHB2PROD with BILLS
4 

•HR 4783 IH

1 ‘‘(B) PRECLUSION OF CERTAIN PRO2 VIDERS.—Pursuant to regulations prescribed by 

3 the Secretary, the Secretary shall bar a health 

4 care entity or provider from furnishing hospital 

5 care or medical services under this section if the 

6 Secretary determines the health care entity or 

7 provider has submitted to the Secretary fraudu8 lent health care claims for payment by the Sec9 retary. 

10 ‘‘(4) OVERDUE CLAIMS.— 

11 ‘‘(A) IN GENERAL.—Any claim that has 

12 not been denied with notice, made pending with 

13 notice, or paid to a health care entity or pro14 vider by the Secretary shall be overdue if the 

15 notice or payment is not received by the health 

16 care entity or provider within the time periods 

17 specified in paragraph (1). 

18 ‘‘(B) INTEREST.— 

19 ‘‘(i) IN GENERAL.—If a claim is over20 due under this paragraph, the Secretary 

21 may, under the requirements established 

22 by paragraph (1) and consistent with the 

23 provisions of chapter 39 of title 31, United 

24 States Code (commonly referred to as the 


lotter on DSKBCFDHB2PROD with BILLS
5 

•HR 4783 IH

1 ‘Prompt Payment Act’), require that inter2 est be paid on clean claims. 

3 ‘‘(ii) COMPUTATION.—Interest paid 

4 under clause (i) shall be computed at the 

5 rate of interest established by the Sec6 retary of the Treasury under section 3902 

7 of title 31, United States Code, and pub8 lished in the Federal Register. 

9 ‘‘(C) REPORT.—Not less frequently than 

10 annually, the Secretary shall submit to Con11 gress a report on payment of overdue claims 

12 under this paragraph, disaggregated by paper 

13 and electronic claims, that includes the fol14 lowing: 

15 ‘‘(i) The amount paid in overdue 

16 claims under this paragraph, disaggregated 

17 by the amount of the overdue claim and 

18 the amount of interest paid on such over19 due claim. 

20 ‘‘(ii) The number of such overdue 

21 claims and the average number of days 

22 late each claim was paid, disaggregated by 

23 facility of the Department and Veterans 

24 Integrated Service Network region. 

25 ‘‘(5) OVERPAYMENT.— 


lotter on DSKBCFDHB2PROD with BILLS
6 

•HR 4783 IH

1 ‘‘(A) IN GENERAL.—Except as provided in 

2 subparagraph (B), the Secretary shall deduct 

3 the amount of any overpayment from payments 

4 due a health care entity or provider under this 

5 section. 

6 ‘‘(B) NOTIFICATION OF RIGHT TO DIS7 PUTE.— 

8 ‘‘(i) IN GENERAL.—Deductions may 

9 not be made under this paragraph unless 

10 the Secretary has made reasonable efforts 

11 to notify a health care entity or provider of 

12 the right to dispute the existence or 

13 amount of such indebtedness and the right 

14 to request a compromise of such indebted15 ness. 

16 ‘‘(ii) DETERMINATION.—The Sec17 retary shall make a determination with re18 spect to any dispute or request under 

19 clause (i) prior to deducting any overpay20 ment under this paragraph unless the time 

21 required to make such a determination be22 fore making any deductions would jeop23 ardize the Secretary’s ability to recover the 

24 full amount of such indebtedness. 


lotter on DSKBCFDHB2PROD with BILLS
7 

•HR 4783 IH

1 ‘‘(6) INFORMATION AND DOCUMENTATION RE2 QUIRED.— 

3 ‘‘(A) IN GENERAL.—The Secretary shall 

4 provide to all health care entities or providers 

5 furnishing hospital care or medical services 

6 under this section a list of information and doc7 umentation that is required to establish a clean 

8 claim under this subsection. 

9 ‘‘(B) CONSULTATION WITH HEALTH CARE

10 ENTITIES.—The Secretary shall consult with 

11 entities in the health care industry, in the pub12 lic and private sector, to determine the informa13 tion and documentation to include in the list 

14 under subparagraph (A). 

15 ‘‘(C) NOTIFICATION OF MODIFICATIONS.— 

16 If the Secretary modifies the information and 

17 documentation included in the list under sub18 paragraph (A), the Secretary shall notify all 

19 health care entities or providers described in 

20 such subparagraph not later than 30 days be21 fore such modifications take effect. 

22 ‘‘(7) PROCESSING OF CLAIMS.—In processing a 

23 claim for compensation for hospital care or medical 

24 services furnished by a health care entity or provider 

25 under this section, the Secretary shall act through— 


lotter on DSKBCFDHB2PROD with BILLS
8 

•HR 4783 IH

1 ‘‘(A) a non-Department entity that has en2 tered into an agreement with the Secretary 

3 under this section; or 

4 ‘‘(B) a non-Department entity that special5 izes in processing such claims for other Federal 

6 agency health care systems. 

7 ‘‘(8) TREATMENT OF CERTAIN OUTSTANDING

8 CLAIMS.— 

9 ‘‘(A) REPORT.—Not later than 30 days 

10 after the date of the enactment of the Veterans 

11 Deserve Better Act, the Secretary shall submit 

12 to the appropriate committees of Congress a re13 port on the number of claims for payment for 

14 hospital care and medical services furnished to 

15 eligible veterans under this section that are out16 standing as of the date of the submittal of the 

17 report. 

18 ‘‘(B) OUTREACH TO PROVIDERS.—Not19 withstanding any other provision of this section, 

20 with respect to each health care entity or pro21 vider that has an outstanding claim for pay22 ment for hospital care and medical services fur23 nished to eligible veterans under this section as 

24 of the date of the enactment of the Veterans 

25 Deserve Better Act, not later than 45 days 


lotter on DSKBCFDHB2PROD with BILLS
9 

•HR 4783 IH

1 after such date of enactment, the Secretary 

2 shall either pay the claim, deny the claim, or re3 quest additional information regarding the 

4 claim. 

5 ‘‘(9) DEFINITIONS.—In this subsection: 

6 ‘‘(A) The term ‘appropriate committees of 

7 Congress’ means— 

8 ‘‘(i) the Committee on Veterans’ Af9 fairs and the Committee on Appropriations 

10 of the Senate; and 

11 ‘‘(ii) the Committee on Veterans’ Af12 fairs and the Committee on Appropriations 

13 of the House of Representatives. 

14 ‘‘(B) The term ‘clean electronic claim’ 

15 means the transmission of data for purposes of 

16 payment of covered health care expenses that is 

17 submitted to the Secretary which contains sub18 stantially all of the required data elements nec19 essary for accurate adjudication, without ob20 taining additional information from the health 

21 care entity or provider that furnished the care 

22 or service, submitted in such format as pre23 scribed by the Secretary in regulations for the 

24 purpose of paying claims for care or services. 


lotter on DSKBCFDHB2PROD with BILLS
10 

•HR 4783 IH

1 ‘‘(C) The term ‘clean paper claim’ means 

2 a paper claim for payment of covered health 

3 care expenses that is submitted to the Secretary 

4 which contains substantially all of the required 

5 data elements necessary for accurate adjudica6 tion, without obtaining additional information 

7 from the health care entity or provider that fur8 nished the care or service, submitted in such 

9 format as prescribed by the Secretary in regula10 tions for the purpose of paying claims for care 

11 or services. 

12 ‘‘(D) The term ‘fraudulent claims’— 

13 ‘‘(i) means the intentional and delib14 erate misrepresentation of a material fact 

15 or facts by a health care entity or provider 

16 made to induce the Secretary to pay a 

17 claim that was not legally payable to that 

18 entity or provider; and 

19 ‘‘(ii) does not include a good faith in20 terpretation by a health care entity or pro21 vider of utilization, medical necessity, cod22 ing, and billing requirements of the Sec23 retary. 

24 ‘‘(E) The term ‘health care entity or pro25 vider’ means any health care entity or provider 


lotter on DSKBCFDHB2PROD with BILLS
11 

•HR 4783 IH

1 that is an entity described in subsection 

2 (a)(1)(B), excluding any Federal health care 

3 entity or provider. 

4 ‘‘(v) INFORMATION ON SCHEDULING APPOINT5 MENTS.—The Secretary shall provide to each eligible vet6 eran who seeks an appointment for care or services under 

7 this section the following: 

8 ‘‘(1) Information on the time required for a vet9 eran to make an appointment for such care or serv10 ices under this section in the region in which the 

11 veteran resides. 

12 ‘‘(2) With respect to appointments made 

13 through third party administrators— 

14 ‘‘(A) information on what will happen if 

15 the third party administrator cannot schedule 

16 an appointment for the provision of such care 

17 or services; 

18 ‘‘(B) a list of other health care providers 

19 in the region in which the veteran resides that 

20 are within the network of the third party ad21 ministrator; and 

22 ‘‘(C) information on how the veteran can 

23 file with the Secretary a complaint concerning 

24 the handling of an appointment by the third 

25 party administrator. 


lotter on DSKBCFDHB2PROD with BILLS
12 

•HR 4783 IH

1 ‘‘(w) REQUIREMENTS OF THIRD PARTY ADMINIS2 TRATORS.— 

3 ‘‘(1) APPOINTMENT TIMING.—The Secretary 

4 shall ensure that each contract with a third party 

5 administrator requires the third party administrator 

6 to schedule an appointment for care or services 

7 under this section for an eligible veteran not later 

8 than five days after the eligible veteran elects to re9 ceive such care or services under this section. 

10 ‘‘(2) TRACKING OF APPOINTMENTS.—The Sec11 retary shall track all appointments for care and 

12 services under this section that are scheduled di13 rectly through a third party administrator. 

14 ‘‘(3) FOLLOW-UP.—The Secretary shall follow 

15 up with a third party administrator regarding any 

16 appointment for care or services under this section 

17 that is pending to be scheduled by the third party 

18 administrator for more than 5 days to determine the 

19 reason for the delay in scheduling the appointment. 

20 ‘‘(4) REPORT ON OVERDUE APPOINTMENTS.— 

21 The Secretary shall require each third party admin22 istrator to submit to the Secretary, not later than 30 

23 days after the date of the enactment of the Veterans 

24 Deserve Better Act, a list of the appointments that, 

25 as of the submittal of the report, have been pending 


lotter on DSKBCFDHB2PROD with BILLS
13 

•HR 4783 IH

1 scheduling by the third party administrator for a pe2 riod of more than 15 days.’’. 

Æ 


lotter on DSKBCFDHB2PROD with BILLS