II 

114TH CONGRESS 

1ST SESSION S. 2179 

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

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

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

provide health care in facilities of the Department or through contracts 

or sharing agreements, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 8, 2015 

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

referred to the Committee on Veterans’ Affairs 

A BILL 

To amend title 38, United States Code, to allow the Secretary of Veterans Affairs to enter into certain agreements with non-Department of Veterans Affairs health 

care providers if the Secretary is not feasibly able to 

provide health care in facilities of the Department or 

through contracts or sharing agreements, and for other 

purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Veteran Care Agree3 ments Rule Enhancement Act’’ or the ‘‘Veteran CARE 

4 Act’’. 

5 SEC. 2. PURPOSE. 

6 The purpose of this Act is— 

7 (1) to maintain the access of veterans to high8 quality hospital care, medical services, and extended 

9 care if that care is not available directly from the 

10 Department of Veterans Affairs; 

11 (2) to continue to allow the use by the Depart12 ment of agreements covered by the Federal Acquisi13 tion Regulation and agreements that are not covered 

14 by such regulation, similar to those agreements used 

15 under the original Medicare fee-for-service program 

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

17 contract for the care needed by veterans through an 

18 agreement covered by such regulation; 

19 (3) to address the fact that individual health 

20 care providers, especially smaller providers in rural 

21 areas, may not be willing to accept veterans as pa22 tients when doing so would require the significant 

23 time and administrative requirements in connection 

24 with entering into agreements with the Department 

25 that are covered by such regulation; 


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1 (4) to address the deficiencies in current law re2 garding agreements entered into by the Department 

3 that have raised legal issues; and 

4 (5) to ensure that agreements that are not cov5 ered by such regulation include robust terms and 

6 conditions that address the quality of health care for 

7 veterans, oversight of the provision of such health 

8 care, and protections for taxpayers. 

9 SEC. 3. AUTHORIZATION OF AGREEMENTS BETWEEN THE 

10 DEPARTMENT OF VETERANS AFFAIRS AND 

11 NON-DEPARTMENT HEALTH CARE PRO12 VIDERS. 

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

14 38, United States Code, is amended by adding after sec15 tion 1703 the following new section: 

16 ‘‘§ 1703A. Veterans Care Agreements with certain 

17 health care providers 

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

19 Secretary is not feasibly able to furnish hospital care, med20 ical services, or extended care under this chapter at facili21 ties of the Department or under contracts or sharing 

22 agreements entered into under authorities other than this 

23 section, the Secretary may furnish such care and services 

24 by entering into agreements under this section with eligi25 ble providers that are certified under subsection (c). An 


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1 agreement entered into under this section may be referred 

2 to as a ‘Veterans Care Agreement’. 

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

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

5 determines that the medical condition of the veteran, the 

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

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

8 of the Department, contracts, or sharing agreements im9 practicable or inadvisable. 

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

11 care or services described in paragraph (1) shall be deter12 mined as if such care or services were furnished in a facil13 ity of the Department and provisions of this title applica14 ble to veterans receiving such care or services in a facility 

15 of the Department shall apply to veterans receiving such 

16 care or services under this section. 

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

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

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

20 and entered into a provider agreement under section 

21 1866(a) of the Social Security Act (42 U.S.C. 

22 1395cc(a)). 

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

24 and entered into a participation agreement under 

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


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

2 payment under a State plan under title XIX of such 

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

4 plan. 

5 ‘‘(4) A provider that is— 

6 ‘‘(A) an Aging and Disability Resource 

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

8 agency (as defined in section 102 of the Older 

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

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

11 defined in section 702 of the Rehabilitation Act 

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

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

14 Secretary considers appropriate for purposes of this 

15 section. 

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

17 The Secretary shall establish a process for the certification 

18 of eligible providers under this section that shall, at a min19 imum, set forth the following: 

20 ‘‘(A) Procedures for the submittal of applica21 tions for certification and deadlines for actions taken 

22 by the Secretary with respect to such applications. 

23 ‘‘(B) Standards and procedures for approval 

24 and denial of certification, duration of certification, 

25 revocation of certification, and recertification. 


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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. 1395cc(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 ‘‘(2) The Secretary shall deny or revoke certification 

9 to an eligible provider under this subsection if the Sec10 retary determines that the eligible provider is currently— 

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

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

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

14 under section 1128 or 1128A of the Social Security 

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

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

17 maintained in the System for Award Management, 

18 or any successor system. 

19 ‘‘(d) TERMS OF AGREEMENTS.—Each agreement en20 tered into with an eligible provider under this section shall 

21 include provisions requiring the eligible provider to do the 

22 following: 

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

24 furnished under this section at rates established by 

25 the Secretary for purposes of this section, which 


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

2 the United States for such care and services to pro3 viders of services and suppliers under the Medicare 

4 program under title XVIII of the Social Security Act 

5 (42 U.S.C. 1395 et seq.). 

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

7 payment in full for care and services furnished 

8 under this section and to not seek any payment for 

9 such care and services from the recipient of such 

10 care and services. 

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

12 and services authorized by the Department under 

13 this section unless the eligible provider receives prior 

14 written consent from the Department to furnish care 

15 or services outside the scope of such authorization. 

16 ‘‘(4) To bill the Department for care and serv17 ices furnished under this section in accordance with 

18 a methodology established by the Secretary for pur19 poses of this section. 

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

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

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

23 or services for which payment is made by the De24 partment under this section. 


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

2 furnished care or services under this section to the 

3 Department in a timeframe and format specified by 

4 the Secretary for purposes of this section. 

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

6 including quality of care assurance standards, as the 

7 Secretary may specify for purposes of this section. 

8 ‘‘(e) TERMINATION OF AGREEMENTS.—(1) An eligi9 ble provider may terminate an agreement with the Sec10 retary under this section at such time and upon such no11 tice to the Secretary as the Secretary may specify for pur12 poses of this section. 

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

14 an eligible provider under this section at such time and 

15 upon such notice to the eligible provider as the Secretary 

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

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

18 to comply substantially with the provisions of the 

19 agreement or with the provisions of this section and 

20 the regulations prescribed thereunder; 

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

22 ‘‘(i) excluded from participation in a Fed23 eral health care program (as defined in section 

24 1128B(f) of the Social Security Act (42 U.S.C. 

25 1320a–7b(f))) under section 1128 or 1128A of 


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

2 and 1320a–7a); or 

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

4 the list maintained in the System for Award 

5 Management, or any successor system; 

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

7 been convicted of a felony or other serious offense 

8 under Federal or State law and determines that the 

9 continued participation of the eligible provider would 

10 be detrimental to the best interests of veterans or 

11 the Department; or 

12 ‘‘(D) determines that it is reasonable to termi13 nate the agreement based on the health care needs 

14 of a veteran or veterans. 

15 ‘‘(f) PERIODIC REVIEW OF CERTAIN AGREE16 MENTS.—(1) Not less frequently than once every two 

17 years, the Secretary shall review each Veterans Care 

18 Agreement of material size entered into during the two19 year period preceding the review to determine whether it 

20 is feasible and advisable to furnish the hospital care, med21 ical services, or extended care furnished under such agree22 ment at facilities of the Department or through contracts 

23 or sharing agreements entered into under authorities other 

24 than this section. 


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

2 Care Agreement is of material size as determined by the 

3 Secretary for purposes of this section. 

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

5 September 30, 2016, for the purchase of extended care 

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

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

8 Secretary may adjust such amount to account for changes 

9 in the cost of health care based upon recognized health 

10 care market surveys and other available data and shall 

11 publish any such adjustments in the Federal Register. 

12 ‘‘(g) EXCLUSION OF CERTAIN FEDERAL CON13 TRACTING PROVISIONS.—(1) An agreement under this 

14 section may be entered into without regard to any law that 

15 would require the Secretary to use competitive procedures 

16 in selecting the party with which to enter into the agree17 ment. 

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

19 unless otherwise provided in this section or regulations 

20 prescribed pursuant to this section, an eligible provider 

21 that enters into an agreement under this section is not 

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

23 that providers of services and suppliers under the Medi24 care program under title XVIII of the Social Security Act 

25 (42 U.S.C. 1395 et seq.) are not subject to. 


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1 ‘‘(B) An eligible provider that enters into an agree2 ment under this section is subject to— 

3 ‘‘(i) all laws regarding integrity, ethics, fraud, 

4 or that subject a person to civil or criminal pen5 alties; and 

6 ‘‘(ii) all laws that protect against employment 

7 discrimination or that otherwise ensure equal em8 ployment opportunities. 

9 ‘‘(h) MONITORING OF QUALITY OF CARE.—The Sec10 retary shall establish a system or systems, consistent with 

11 survey and certification procedures used by the Centers 

12 for Medicare & Medicaid Services and State survey agen13 cies to the extent practicable— 

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

15 furnished to veterans under this section; and 

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

17 furnished by an eligible provider for purposes of de18 termining whether to renew an agreement under this 

19 section with the eligible provider. 

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

21 establish administrative procedures for eligible providers 

22 with which the Secretary has entered an agreement under 

23 this section to present any dispute arising under or related 

24 to the agreement. 


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

2 under chapter 71 of title 41 with respect to a dispute aris3 ing under an agreement under this section, an eligible pro4 vider must first exhaust the administrative procedures es5 tablished by the Secretary under paragraph (1).’’. 

6 (b) REGULATIONS.—The Secretary of Veterans Af7 fairs shall prescribe an interim final rule to carry out sec8 tion 1703A of such title, as added by subsection (a), not 

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

10 Act. 

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

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

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

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

15 SEC. 4. MODIFICATION OF AUTHORITY TO ENTER INTO 

16 AGREEMENTS WITH STATE HOMES TO PRO17 VIDE NURSING HOME CARE. 

18 (a) USE OF AGREEMENTS.— 

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

20 1745(a) of title 38, United States Code, is amended, 

21 in the matter preceding subparagraph (A), by strik22 ing ‘‘a contract (or agreement under section 

23 1720(c)(1) of this title)’’ and inserting ‘‘an agree24 ment’’. 


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

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

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

4 (b) EXCLUSION OF CERTAIN FEDERAL CON5 TRACTING PROVISIONS.—Such section is amended by add6 ing at the end the following new paragraph: 

7 ‘‘(4)(A) An agreement under this section may be en8 tered into without regard to any law that would require 

9 the Secretary to use competitive procedures in selecting 

10 the party with which to enter into the agreement. 

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

12 otherwise provided in this section or regulations prescribed 

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

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

15 carrying out of the agreement, any law that providers of 

16 services and suppliers under the Medicare program under 

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

18 et seq.) are not subject to. 

19 ‘‘(ii) An eligible provider that enters into an agree20 ment under this section is subject to— 

21 ‘‘(I) all laws regarding integrity, ethics, fraud, 

22 or that subject a person to civil or criminal pen23 alties; and 


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1 ‘‘(II) all laws that protect against employment 

2 discrimination or that otherwise ensure equal em3 ployment opportunities.’’. 

4 (c) EFFECTIVE DATE.— 

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

6 this section shall apply to agreements entered into 

7 under section 1745 of such title on and after the 

8 date on which the regulations prescribed by the Sec9 retary of Veterans Affairs to implement such amend10 ments take effect. 

11 (2) PUBLICATION.—The Secretary shall publish 

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

13 Register not later than 30 days before such date. 

Æ 


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