I 

115TH CONGRESS 

2D SESSION H. R. 5047 

To direct the Secretary of Veterans Affairs to carry out a demonstration 

program to provide expanded access to medical services through partnerships between Department of Veterans Affairs medical centers and Federally Qualified Health Centers, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 15, 2018 

Mr. BILIRAKIS (for himself, Ms. KUSTER of New Hampshire, Mr. ARRINGTON, 

Mr. COFFMAN, and Mr. PETERS) introduced the following bill; which was 

referred to the Committee on Veterans’ Affairs 

A BILL 

To direct the Secretary of Veterans Affairs to carry out 

a demonstration program to provide expanded access to 

medical services through partnerships between Department of Veterans Affairs medical centers and Federally 

Qualified Health Centers, 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 ‘‘VA Community Care 

5 Enhancement Act’’. 


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1 SEC. 2. DEPARTMENT OF VETERANS AFFAIRS DEMONSTRA2 TION PROGRAM ON EXPANDED AVAILABILITY 

3 OF MEDICAL SERVICES THROUGH CON4 TRACTS WITH FEDERALLY QUALIFIED 

5 HEALTH CENTERS. 

6 (a) DEMONSTRATION PROGRAM.—The Secretary of 

7 Veterans Affairs shall carry out a demonstration program 

8 under which the Secretary shall furnish certain medical 

9 services under chapter 17 of title 38, United States Code, 

10 through contracts between Department of Veterans Af11 fairs medical centers and Federally Qualified Health Cen12 ters (hereinafter referred to as ‘‘FQHCs’’). 

13 (b) COMMUNITY-CARE COLLABORATIVE ARRANGE14 MENTS.—Under the demonstration program, the Sec15 retary shall enter into contracts, on behalf of Department 

16 medical centers, with not less than five separate FQHCs 

17 that meet the selection criteria under subsection (c). Such 

18 a contract shall provide that— 

19 (1) a Department medical provider at the med20 ical center may refer patients directly to the FQHC, 

21 without any requirement to consult with other agen22 cies, offices, or units within the Department or with 

23 entities under contract with the Department; 

24 (2) all patient referrals to the FQHC are at the 

25 discretion of the Department medical provider, and 


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1 the decision whether to accept such a referral will be 

2 at the discretion of the patient; 

3 (3) if a patient accepts such a referral, the 

4 FQHC agrees to accept the patient; 

5 (4) if the FQHC accepts the patient, the 

6 FQHC shall provide medical services to the patient 

7 only to the extent that such services are available 

8 from the FQHC pursuant to section 330 of the Pub9 lic Health Service Act (42 U.S.C. 254b); 

10 (5) if a patient accepted by the FQHC is a vet11 eran, the FQHC shall accept the family members of 

12 the veteran and shall provide care and services to 

13 such family members in accordance with chapter 17 

14 of title 38, United States Code, if such family mem15 bers are eligible for medical services under such 

16 chapter; 

17 (6) if a patient referred under the demonstra18 tion program is not eligible for a type of care or 

19 service needed by the patient under chapter 17 of 

20 title 38, United States Code, the FQHC agrees to 

21 provide such care or service to the patient, and ac22 cept payment for such care or service, in accordance 

23 with section 330 of the Public Health Service Act 

24 (42 U.S.C. 254b); 


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1 (7) the FQHC agrees to provide to patients re2 ferred under the demonstration program— 

3 (A) in consultation with the Department 

4 medical center, appropriate education on what 

5 care and services may be provided to the pa6 tient under chapter 17 of title 38, United 

7 States Code, and what care and services may 

8 not be provided under such title; and 

9 (B) appropriate education on what care 

10 and services are provided under section 330 of 

11 the Public Health Service Act (42 U.S.C. 254b) 

12 and what care and services are not provided 

13 under such section; 

14 (8) the FQHC agrees to provide medical serv15 ices to the veteran in a context that sufficiently 

16 takes into account the culture of members of the 

17 uniformed services, veterans, and family members 

18 and caregivers of members of the uniformed services 

19 and veterans, including the experience of combat 

20 and the experience of military sexual trauma; 

21 (9) the medical center and the FQHC agree to 

22 cooperate to ensure that patients referred under the 

23 demonstration program are patients of both the 

24 medical center and the FQHC and, for such pur25 poses, to ensure interoperability, to the extent pracVerDate Sep 11 2014 20:38 Feb 26, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5047.IH H5047

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1 ticable, in terms of sharing the electronic health 

2 records of the patients; 

3 (10) the FQHC agrees to begin providing care 

4 and services to a referred patient promptly after re5 ceiving the referral, without regard to whether the 

6 patient has completed the process of enrolling in the 

7 patient enrollment system under section 1705 of 

8 title 38, United States Code; 

9 (11) with respect to a patient who is a veteran 

10 who has not completed such enrollment process as of 

11 the time the referral is made, the FQHC agrees to— 

12 (A) in coordination with the medical cen13 ter, make available to the veteran assistance 

14 with the enrollment process; and 

15 (B) accept that reimbursement from the 

16 Secretary for providing care or services to the 

17 veteran will be delayed until after the enroll18 ment process is completed; 

19 (12) the FQHC agrees to accept the financial 

20 risk that a patient referred under the demonstration 

21 program may not qualify for care or services fur22 nished by the Secretary under title 38, United 

23 States Code; 

24 (13) the FQHC agrees to make available to re25 ferred patients, at one or more services sites of the 


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1 FQHC and in accordance with the limitations on the 

2 scope of services applicable under section 330 of the 

3 Public Health Service Act (42 U.S.C. 245b)— 

4 (A) behavioral and mental health and sub5 stance abuse services; 

6 (B) women’s health services, including 

7 OBGYN services; 

8 (C) audiology; 

9 (D) HIV and hepatitis C treatment; 

10 (E) dental care; 

11 (F) optometry and ophthalmology; 

12 (G) pain management; 

13 (H) internal medicine; 

14 (I) cancer detection and screening; 

15 (J) podiatry; and 

16 (K) urgent care; 

17 (14) the FQHC agrees to provide additional 

18 services to referred patients to enable such patients 

19 to access medical services furnished under the dem20 onstration program, including outreach and trans21 portation services; 

22 (15) the Secretary agrees to provide timely re23 imbursement to the FQHC for medical services, pro24 vided to referred patients at the applicable rate for 

25 the State in which the FQHC is located under secVerDate Sep 11 2014 20:38 Feb 26, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5047.IH H5047

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1 tion 1902(bb) of the Social Security Act (42 U.S.C. 

2 1396a); 

3 (16) the FQHC agrees to undergo periodic au4 dits in accordance with section 330 of the Public 

5 Health Service Act (42 U.S.C. 254b) and title XIX 

6 of the Social Security Act (42 U.S.C. 1396 et seq.); 

7 and 

8 (17) to the extent practicable, the medical cen9 ter agrees to provide information to patients on the 

10 availability in such area of medical services through 

11 the participation of the FQHC in the demonstration 

12 program, including information on the particular 

13 services that are available from the FQHC and on 

14 the extent to which the patient will be required to 

15 make payments for such service. 

16 (c) SELECTION CRITERIA.— 

17 (1) IN GENERAL.—In order to select FQHCs 

18 with which to enter into contracts under subsection 

19 (b), the Secretary shall develop selection criteria. 

20 Such selection criteria shall— 

21 (A) take into account geographic and de22 mographic differences across catchment areas, 

23 as defined by the Veterans Health Administra24 tion; 


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1 (B) provide for the selection of one or 

2 more FQHCs that have not fewer than two 

3 service sites, including one service site in a 

4 highly rural area; 

5 (C) provide for the selection of one or more 

6 FQHCs that— 

7 (i) have a large number of service 

8 sites; 

9 (ii) have a service area— 

10 (I) in which a significant number 

11 of veterans reside; 

12 (II) that includes both rural and 

13 urban areas, and one or more Depart14 ment medical centers; and 

15 (III) that is located within 100 

16 miles of a military base; 

17 (iii) is participating in a network 

18 that— 

19 (I) provides connectivity with re20 spect to electronic health records; and 

21 (II) includes one or more Depart22 ment medical centers as participants; 

23 and 

24 (iv) has engaged in outreach to one or 

25 more Department medical centers toward 


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1 collaborating on the provision of services to 

2 veterans; 

3 (D) require that a selected FQHC has the 

4 capability to assist veterans in navigating the 

5 benefits available to them under the laws ad6 ministered by the Secretary of Veterans Affairs; 

7 and 

8 (E) require a selected FQHC to commit to 

9 establishing a program to educate health pro10 fessionals employed by the FQHC on cultural 

11 competency in providing services to veterans. 

12 (2) APPROVAL OF CERTAIN FQHCS.—Each con13 tract entered into under subsection (b) shall specify 

14 the date on which the FQHC agrees to begin pro15 viding medical services to patients referred by a 

16 medical provider at a Department of Veterans Af17 fairs medical center under the contract. Such date 

18 may not be later than 180 days after the date on 

19 which the Secretary and the FQHC enter into the 

20 contract. 

21 (d) COORDINATION WITH DEPARTMENT OF HEALTH

22 AND HUMAN SERVICES.—In carrying out the demonstra23 tion program under this section, the Secretary of Veterans 

24 Affairs shall consult with the Secretary of Health and 

25 Human Services (acting through the Administrator of the 


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1 Health Resources and Services Administration), who shall 

2 provide to the Secretary of Veterans Affairs information 

3 on the capacity of FQHCs to serve veterans. With respect 

4 to FQHCs that are participating in such demonstration 

5 program, the Secretary of Health and Human Services 

6 may, subject to that availability of appropriations for such 

7 purpose, make payments to such FQHCs to increase such 

8 capacity. 

9 (e) PATIENT ENROLLMENT.— 

10 (1) NON-ENROLLED VETERANS.—Notwith11 standing subsection (c) of section 1705 of title 38, 

12 United States Code, the Secretary shall develop a 

13 process to refer veterans who are not enrolled in the 

14 patient enrollment system of the Department of Vet15 erans Affairs under such section to an FQHC for 

16 the provision of medical services to the veteran 

17 under the pilot program. 

18 (2) FACILITATION OF ENROLLMENT.—The Sec19 retary shall develop a process by which FQHCs that 

20 have entered into a contract with the Secretary 

21 under subsection (b) are able to facilitate the enroll22 ment of veterans referred to the FQHC under para23 graph (1) in such patient enrollment system. 

24 (f) ELECTRONIC HEALTH RECORDS.—The Secretary 

25 of Veterans Affairs shall provide notice to any veteran acVerDate Sep 11 2014 20:38 Feb 26, 2018 Jkt 079200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H5047.IH H5047

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1 cepting a referral to an FQHC under the demonstration 

2 program that such acceptance shall serve as consent for 

3 the Department medical center and the FQHC to share 

4 electronic health records unless the veteran elects not to 

5 authorize such sharing of records using a form provided 

6 by the Secretary for such purpose. 

7 (g) RULE OF CONSTRUCTION.—Nothing in this sec8 tion shall be construed as affecting— 

9 (1) any authority or obligation of the Secretary 

10 of Veterans Affairs to furnish medical services under 

11 chapter 17 of title 38, United States Code, to a pa12 tient who is referred to an FQHC under the dem13 onstration program; 

14 (2) the eligibility of any individual to receive 

15 medical services under chapter 17 of title 38, United 

16 States Code; or 

17 (3) section 330 of the Public Health Service 

18 Act (42 U.S.C. 254b). 

19 (h) FUNDING.—No additional amounts are author20 ized to be appropriated to carry out this section. The Sec21 retary shall carry out the demonstration program using 

22 amounts otherwise available to the Secretary for Medical 

23 Community Care for fiscal years 2018 through 2022. 

24 (i) DURATION; TERMINATION.— 


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1 (1) DURATION.—The Secretary of Veterans Af2 fairs may enter into contracts under the demonstra3 tion program during the three-year period beginning 

4 on the date of the enactment of this Act. Such pe5 riod may be extended or made permanent at the dis6 cretion of the Secretary. 

7 (2) PROVISION OF CARE.—If the Secretary ter8 minates the demonstration program under this sec9 tion, the Secretary shall ensure that patients receiv10 ing care or services through a FQHC pursuant to a 

11 contract entered into under subsection (b) are able 

12 to receive medical services provided by the FQHC 

13 under such contract until the conclusion of the rel14 evant episode of care. 

15 (j) DEFINITION OF FEDERALLY QUALIFIED HEALTH

16 CENTER.—The term ‘‘Federally Qualified Health Center’’ 

17 means an entity receiving a grant under section 330 of 

18 the Public Health Service Act (42 U.S.C. 254b) or any 

19 other entity described in section 1861(aa)(4) of the Social 

20 Security Act. 

Æ 


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