veteran is provided by a medical facility of the 
Department that is reasonably accessible to a 
covered veteran. 
‘‘(iii) Whether a medical condition of the 
covered veteran affects the ability of the covered 
veteran to travel. 
‘‘(iv) Whether there is compelling reason, 
as determined by the Secretary, that the vet-
eran needs to receive hospital care, medical 
services, or extended care services from a med-
ical facility other than a medical facility of the 
Department. 
‘‘(v) Such other considerations as the Sec-
retary considers appropriate. 
‘‘(3) If the Secretary has determined that the Depart-
ment does not offer the care or services the covered vet-
eran requires under subparagraph (A) of paragraph (1), 
that the Department does not operate a full-service med-
ical facility in the State in which the covered veteran re-
sides under subparagraph (B) of such paragraph, that the 
covered veteran is described under subparagraph (C) of 
such paragraph, or that the Department is not able to fur-
nish care or services in a manner that complies with des-
ignated access standards developed by the Secretary under 
section 1703B of this title under subparagraph (D) of 
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such paragraph, the decision to receive hospital care, med-
ical services, or extended care services under such sub-
paragraphs from a health care provider specified in sub-
section (c) shall be at the election of the veteran. 
‘‘(e) CONDITIONS UNDER WHICH CARE IS AUTHOR-
IZED TO BE FURNISHED THROUGH NON-DEPARTMENT 
PROVIDERS.—(1)(A) The Secretary may furnish hospital 
care, medical services, or extended care services through 
a health care provider specified in subsection (c) to a cov-
ered veteran served by a medical service line of the De-
partment that the Secretary has determined is not pro-
viding care that complies with the standards for quality 
the Secretary shall establish under section 1703C. 
‘‘(B) In carrying out subparagraph (A), the Secretary 
shall— 
‘‘(i) measure timeliness of the medical service 
line at a facility of the Department when compared 
with the same medical service line at different De-
partment facilities; and 
‘‘(ii) measure quality at a medical service line 
of a facility of the Department by comparing it with 
two or more distinct and appropriate quality meas-
ures at non-Department medical service lines. 
‘‘(C)(i) The Secretary may not concurrently furnish 
hospital care, medical services, or extended care services 
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under subparagraph (A) with respect to more than three 
medical service lines described in such subparagraph at 
any one health care facility of the Department. 
‘‘(ii) The Secretary may not concurrently furnish hos-
pital care, medical services, or extended care services 
under subparagraph (A) with respect to more than 36 
medical service lines nationally described in such subpara-
graph. 
‘‘(2) The Secretary may limit the types of hospital 
care, medical services, or extended care services covered 
veterans may receive under paragraph (1) in terms of the 
length of time such care and services will be available, the 
location at which such care and services will be available, 
and the clinical care and services that will be available. 
‘‘(3)(A) Except as provided for in subparagraph (B), 
the hospital care, medical services, and extended care serv-
ices authorized under paragraph (1) with respect to a 
medical service line shall cease when the remediation de-
scribed in section 1706A with respect to such medical 
service line is complete. 
‘‘(B) The Secretary shall ensure continuity and co-
ordination of care for any veteran who elects to receive 
care or services under paragraph (1) from a health care 
provider specified in subsection (c) through the completion 
of an episode of care. 
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‘‘(4) The Secretary shall publish in the Federal Reg-
ister, and shall take all reasonable steps to provide direct 
notice to covered veterans affected under this subsection, 
at least once each year stating the time period during 
which such care and services will be available, the location 
or locations where such care and services will be available, 
and the clinical services available at each location under 
this subsection in accordance with regulations the Sec-
retary shall prescribe. 
‘‘(5) When the Secretary exercises the authority 
under paragraph (1), the decision to receive care or serv-
ices under such paragraph from a health care provider 
specified in subsection (c) shall be at the election of the 
covered veteran. 
‘‘(f) REVIEW OF DECISIONS.—The review of any de-
cision under subsection (d) or (e) shall be subject to the 
Department’s clinical appeals process, and such decisions 
may not be appealed to the Board of Veterans’ Appeals. 
‘‘(g) TIERED NETWORK.—(1) To promote the provi-
sion of high-quality and high-value hospital care, medical 
services, and extended care services under this section, the 
Secretary may develop a tiered provider network of eligible 
providers based on criteria established by the Secretary 
for purposes of this section. 
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‘‘(2) In developing a tiered provider network of eligi-
ble providers under paragraph (1), the Secretary shall not 
prioritize providers in a tier over providers in any other 
tier in a manner that limits the choice of a covered veteran 
in selecting a health care provider specified in subsection 
(c) for receipt of hospital care, medical services, or ex-
tended care services under this section. 
‘‘(h) CONTRACTS TO ESTABLISH NETWORKS
OF 
HEALTH CARE PROVIDERS.—(1) The Secretary shall 
enter into consolidated, competitively bid contracts to es-
tablish networks of health care providers specified in para-
graphs (1) and (5) of subsection (c) for purposes of pro-
viding sufficient access to hospital care, medical services, 
or extended care services under this section. 
‘‘(2)(A) The Secretary shall, to the extent practicable, 
ensure that covered veterans are able to make their own 
appointments using advanced technology. 
‘‘(B) To the extent practicable, the Secretary shall 
be responsible for the scheduling of appointments for hos-
pital care, medical services, and extended care services 
under this section. 
‘‘(3)(A) The Secretary may terminate a contract with 
an entity entered into under paragraph (1) at such time 
and upon such notice to the entity as the Secretary may 
specify for purposes of this section, if the Secretary noti-
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fies the appropriate committees of Congress that, at a 
minimum— 
‘‘(i) the entity— 
‘‘(I) failed to comply substantially with the 
provisions of the contract or with the provisions 
of this section and the regulations prescribed 
under this section; 
‘‘(II) failed to comply with the access 
standards or the standards for quality estab-
lished by the Secretary; 
‘‘(III) is excluded from participation in a 
Federal health care program (as defined in sec-
tion 1128B(f) of the Social Security Act (42 
U.S.C. 1320a–7b(f))) under section 1128 or 
1128A of the Social Security Act (42 U.S.C. 
1320a–7 and 1320a–7a); 
‘‘(IV) is identified as an excluded source 
on the list maintained in the System for Award 
Management, or any successor system; or 
‘‘(V) has been convicted of a felony or 
other serious offense under Federal or State 
law and the continued participation of the enti-
ty would be detrimental to the best interests of 
veterans or the Department; 
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‘‘(ii) it is reasonable to terminate the contract 
based on the health care needs of veterans; or 
‘‘(iii) it is reasonable to terminate the contract 
based on coverage provided by contracts or sharing 
agreements entered into under authorities other 
than this section. 
‘‘(B) Nothing in subparagraph (A) may be construed 
to restrict the authority of the Secretary to terminate a 
contract entered into under paragraph (1) under any other 
provision of law. 
‘‘(4) Whenever the Secretary provides notice to an 
entity that the entity is failing to meet contractual obliga-
tions entered into under paragraph (1), the Secretary shall 
submit to the Committee on Veterans’ Affairs of the Sen-
ate and the Committee on Veterans’ Affairs of the House 
of Representatives a report on such failure. Such report 
shall include the following: 
‘‘(A) An explanation of the reasons for pro-
viding such notice. 
‘‘(B) A description of the effect of such failure, 
including with respect to cost, schedule, and require-
ments. 
‘‘(C) A description of the actions taken by the 
Secretary to mitigate such failure. 
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‘‘(D) A description of the actions taken by the 
contractor to address such failure. 
‘‘(E) A description of any effect on the commu-
nity provider market for veterans in the affected 
area. 
‘‘(5)(A) The Secretary shall instruct each entity 
awarded a contract under paragraph (1) to recognize and 
accept, on an interim basis, the credentials and qualifica-
tions of health care providers who are authorized to fur-
nish hospital care and medical services to veterans under 
a community care program of the Department in effect 
as of the day before the date of the enactment of the Car-
ing for Our Veterans Act of 2018, including under the 
Patient-Centered Community Care Program and the Vet-
erans Choice Program under section 101 of the Veterans 
Access, Choice, and Accountability Act of 2014 (Public 
Law 113–146; 38 U.S.C. 1701 note), as qualified pro-
viders under the program established under this section. 
‘‘(B) The interim acceptance period under subpara-
graph (A) shall be determined by the Secretary based on 
the following criteria: 
‘‘(i) With respect to a health care provider, 
when the current certification agreement for the 
health care provider expires. 
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‘‘(ii) Whether the Department has enacted cer-
tification and eligibility criteria and regulatory pro-
cedures by which non-Department providers will be 
authorized under this section. 
‘‘(6) The Secretary shall establish a system or sys-
tems for monitoring the quality of care provided to covered 
veterans through a network under this subsection and for 
assessing the quality of hospital care, medical services, 
and extended care services furnished through such net-
work before the renewal of the contract for such network. 
‘‘(i) PAYMENT RATES FOR CARE AND SERVICES.— 
(1) Except as provided in paragraph (2), and to the extent 
practicable, the rate paid for hospital care, medical serv-
ices, or extended care services under any provision in this 
title may not exceed the rate paid by the United States 
to a provider of services (as defined in section 1861(u) 
of the Social Security Act (42 U.S.C. 1395x(u))) or a sup-
plier (as defined in section 1861(d) of such Act (42 U.S.C. 
1395x(d))) under the Medicare program under title XI or 
title XVIII of the Social Security Act (42 U.S.C. 1301 
et seq.), including section 1834 of such Act (42 U.S.C. 
1395m), for the same care or services. 
‘‘(2)(A) A higher rate than the rate paid by the 
United States as described in paragraph (1) may be nego-
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tiated with respect to the furnishing of care or services 
to a covered veteran who resides in a highly rural area. 
‘‘(B) In this paragraph, the term ‘highly rural area’ 
means an area located in a county that has fewer than 
seven individuals residing in that county per square mile. 
‘‘(3) With respect to furnishing care or services under 
this section in Alaska, the Alaska Fee Schedule of the De-
partment of Veterans Affairs shall be followed, except for 
when another payment agreement, including a contract or 
provider agreement, is in effect. 
‘‘(4) With respect to furnishing hospital care, medical 
services, or extended care services under this section in 
a State with an All-Payer Model Agreement under section 
1814(b)(3) of the Social Security Act (42 U.S.C. 
1395f(b)(3)) that became effective on or after January 1, 
2014, the Medicare payment rates under paragraph 
(2)(A) shall be calculated based on the payment rates 
under such agreement. 
‘‘(5) Notwithstanding paragraph (1), the Secretary 
may incorporate, to the extent practicable, the use of 
value-based reimbursement models to promote the provi-
sion of high-quality care. 
‘‘(6) With respect to hospital care, medical services, 
or extended care services for which there is not a rate paid 
under the Medicare program as described in paragraph 
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(1), the rate paid for such care or services shall be deter-
mined by the Secretary. 
‘‘(j) TREATMENT OF OTHER HEALTH PLAN CON-
TRACTS.—In any case in which a covered veteran is fur-
nished hospital care, medical services, or extended care 
services under this section for a non-service-connected dis-
ability described in subsection (a)(2) of section 1729 of 
this title, the Secretary shall recover or collect reasonable 
charges for such care or services from a health plan con-
tract described in section 1729 in accordance with such 
section. 
‘‘(k) PAYMENT
BY VETERAN.—A covered veteran 
shall not pay a greater amount for receiving care or serv-
ices under this section than the amount the veteran would 
pay for receiving the same or comparable care or services 
at a medical facility of the Department or from a health 
care provider of the Department. 
‘‘(l) TRANSPLANT AUTHORITY FOR IMPROVED AC-
CESS.—(1) In the case of a covered veteran described in 
paragraph (2), the Secretary shall determine whether to 
authorize an organ or bone marrow transplant for that 
covered veteran at a non-Department facility. 
‘‘(2) A covered veteran described in this paragraph— 
‘‘(A) requires an organ or bone marrow trans-
plant; and 
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‘‘(B) has, in the opinion of the primary care 
provider of the veteran, a medically compelling rea-
son to travel outside the region of the Organ Pro-
curement and Transplantation Network, established 
under section 372 of the National Organ Transplan-
tation Act (Public Law 98–507; 42 U.S.C. 274), in 
which the veteran resides, to receive such transplant. 
‘‘(m) MONITORING OF CARE PROVIDED.—(1)(A) Not 
later than 540 days after the date of the enactment of 
the Caring for Our Veterans Act of 2018, and not less 
frequently than annually thereafter, the Secretary shall 
submit to appropriate committees of Congress a review of 
the types and frequency of care sought under subsection 
(d). 
‘‘(B) The review submitted under subparagraph (A) 
shall include an assessment of the following: 
‘‘(i) The top 25 percent of types of care and 
services most frequently provided under subsection 
(d) due to the Department not offering such care 
and services. 
‘‘(ii) The frequency such care and services were 
sought by covered veterans under this section. 
‘‘(iii) An analysis of the reasons the Depart-
ment was unable to provide such care and services. 
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‘‘(iv) Any steps the Department took to provide 
such care and services at a medical facility of the 
Department. 
‘‘(v) The cost of such care and services. 
‘‘(2) In monitoring the hospital care, medical serv-
ices, and extended care services furnished under this sec-
tion, the Secretary shall do the following: 
‘‘(A) With respect to hospital care, medical 
services, and extended care services furnished 
through provider networks established under sub-
section (i)— 
‘‘(i) compile data on the types of hospital 
care, medical services, and extended care serv-
ices furnished through such networks and how 
many patients used each type of care and serv-
ice; 
‘‘(ii) identify gaps in hospital care, medical 
services, or extended care services furnished 
through such networks; 
‘‘(iii) identify how such gaps may be fixed 
through new contracts within such networks or 
changes in the manner in which hospital care, 
medical services, or extended care services are 
furnished through such networks; 
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erans under this section by medical facilities oper-
ated by Federal agencies other than the Depart-
ment. 
‘‘(3) Not later than 540 days after the date of the 
enactment of the Caring for Our Veterans Act of 2018 
and not less frequently than once each year thereafter, the 
Secretary shall submit to the Committee on Veterans’ Af-
fairs of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a report on the in-
formation gathered under paragraph (2). 
‘‘(n) PROHIBITION ON CERTAIN LIMITATIONS.—(1) 
The Secretary shall not limit the types of hospital care, 
medical services, or extended care services covered vet-
erans may receive under this section if it is in the best 
medical interest of the veteran to receive such hospital 
care, medical services, or extended care services, as deter-
mined by the veteran and the veteran’s health care pro-
vider. 
‘‘(2) No provision in this section may be construed 
to alter or modify any other provision of law establishing 
specific eligibility criteria for certain hospital care, medical 
services, or extended care services. 
‘‘(o) DEFINITIONS.—In this section: 
‘‘(1) The term ‘appropriate committees of Con-
gress’ means— 
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‘‘(A) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
Senate; and 
‘‘(B) the Committee on Veterans’ Affairs 
and the Committee on Appropriations of the 
House of Representatives. 
‘‘(2) The term ‘medical service line’ means a 
clinic within a Department medical center.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 17 is amended by 
striking the item relating to section 1703 and insert-
ing the following new item: 
‘‘1703. Veterans Community Care Program.’’. 
(b) EFFECTIVE DATE.—Section 1703 of title 38, 
United States Code, as amended by subsection (a), shall 
take effect on the later of— 
(1) the date that is 30 days after the date on 
which the Secretary of Veterans Affairs submits the 
report required under section 101(q)(2) of the Vet-
erans Access, Choice, and Accountability Act of 
2014 (Public Law 113–146; 38 U.S.C. 1701 note); 
or 
(2) the date on which the Secretary promul-
gates regulations pursuant to subsection (c). 
(c) REGULATIONS.— 
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(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall promulgate regula-
tions to carry out section 1703 of title 38, United 
States Code, as amended by subsection (a) of this 
section. 
(2) UPDATES.— 
(A) PERIODIC.—Before promulgating the 
regulations required under paragraph (1), the 
Secretary shall provide to the appropriate com-
mittees of Congress periodic updates to confirm 
the progress of the Secretary toward developing 
such regulations. 
(B) FIRST
UPDATE.—The first update 
under subparagraph (A) shall occur no later 
than 120 days from the date of the enactment 
of this Act. 
(C) APPROPRIATE COMMITTEES OF CON-
GRESS DEFINED.—In this paragraph, the term 
‘‘appropriate committees of Congress’’ means— 
(i) the Committee on Veterans’ Af-
fairs and the Committee on Appropriations 
of the Senate; and 
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(ii) the Committee on Veterans’ Af-
fairs and the Committee on Appropriations 
of the House of Representatives. 
(d) CONTINUITY OF EXISTING AGREEMENTS.— 
(1) IN
GENERAL.—Notwithstanding section 
1703 of title 38, United States Code, as amended by 
subsection (a), the Secretary of Veterans Affairs 
shall continue all contracts, memorandums of under-
standing, memorandums of agreements, and other 
arrangements that were in effect on the day before 
the date of the enactment of this Act between the 
Department of Veterans Affairs and the American 
Indian and Alaska Native health care systems as es-
tablished under the terms of the Department of Vet-
erans Affairs and Indian Health Service Memo-
randum of Understanding, signed October 1, 2010, 
the National Reimbursement Agreement, signed De-
cember 5, 2012, arrangements under section 405 of 
the Indian Health Care Improvement Act (25 U.S.C. 
1645), and agreements entered into under sections 
102 and 103 of the Veterans Access, Choice, and 
Accountability Act of 2014 (Public Law 113–146). 
(2) MODIFICATIONS.—Paragraph (1) shall not 
be construed to prohibit the Secretary and the par-
ties to the contracts, memorandums of under-
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standing, memorandums of agreements, and other 
arrangements described in such paragraph from 
making such changes to such contracts, memoran-
dums of understanding, memorandums of agree-
ments, and other arrangements as may be otherwise 
authorized pursuant to other provisions of law or the 
terms of the contracts, memorandums of under-
standing, memorandums of agreements, and other 
arrangements. 
SEC. 102. AUTHORIZATION OF AGREEMENTS BETWEEN DE-
PARTMENT OF VETERANS AFFAIRS AND NON- 
DEPARTMENT PROVIDERS. 
(a) IN GENERAL.—Subchapter I of chapter 17 is 
amended by inserting after section 1703 the following new 
section: 
‘‘§ 1703A. Agreements with eligible entities or pro-
viders; certification processes 
‘‘(a) AGREEMENTS AUTHORIZED.—(1)(A) When hos-
pital care, a medical service, or an extended care service 
required by a veteran who is entitled to such care or serv-
ice under this chapter is not feasibly available to the vet-
eran from a facility of the Department or through a con-
tract or sharing agreement entered into pursuant to an-
other provision of law, the Secretary may furnish such 
care or service to such veteran through an agreement 
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under this section with an eligible entity or provider to 
provide such hospital care, medical service, or extended 
care service. 
‘‘(B) An agreement entered into under this section 
to provide hospital care, a medical service, or an extended 
care service shall be known as a ‘Veterans Care Agree-
ment’. 
‘‘(C) For purposes of subparagraph (A), hospital 
care, a medical service, or an extended care service may 
be considered not feasibly available to a veteran from a 
facility of the Department or through a contract or shar-
ing agreement described in such subparagraph when the 
Secretary determines the veteran’s medical condition, the 
travel involved, the nature of the care or services required, 
or a combination of these factors make the use of a facility 
of the Department or a contract or sharing agreement de-
scribed in such subparagraph impracticable or inadvisable. 
‘‘(D) A Veterans Care Agreement may be entered 
into by the Secretary or any Department official author-
ized by the Secretary. 
‘‘(2)(A) Subject to subparagraph (B), the Secretary 
shall review each Veterans Care Agreement of material 
size, as determined by the Secretary or set forth in para-
graph (3), for hospital care, a medical service, or an ex-
tended care service to determine whether it is feasible and 
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advisable to provide such care or service within a facility 
of the Department or by contract or sharing agreement 
entered into pursuant to another provision of law and, if 
so, take action to do so. 
‘‘(B)(i) The Secretary shall review each Veterans 
Care Agreement of material size that has been in effect 
for at least six months within the first two years of its 
taking effect, and not less frequently than once every four 
years thereafter. 
‘‘(ii) If a Veterans Care Agreement has not been in 
effect for at least six months by the date of the review 
required by subparagraph (A), the agreement shall be re-
viewed during the next cycle required by subparagraph 
(A), and such review shall serve as its review within the 
first two years of its taking effect for purposes of clause 
(i). 
‘‘(3)(A) In fiscal year 2019 and in each fiscal year 
thereafter, in addition to such other Veterans Care Agree-
ments as the Secretary may determine are of material size, 
a Veterans Care Agreement for the purchase of extended 
care services that exceeds $5,000,000 annually shall be 
considered of material size. 
‘‘(B) From time to time, the Secretary may publish 
a notice in the Federal Register to adjust the dollar 
amount specified in subparagraph (A) to account for 
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changes in the cost of health care based upon recognized 
health care market surveys and other available data. 
‘‘(b) ELIGIBLE ENTITIES
AND PROVIDERS.—For 
purposes of this section, an eligible entity or provider is— 
‘‘(1) any provider of services that has enrolled 
and entered into a provider agreement under section 
1866(a) of the Social Security Act (42 U.S.C. 
1395cc(a)) and any physician or other supplier who 
has enrolled and entered into a participation agree-
ment under section 1842(h) of such Act (42 U.S.C. 
1395u(h)); 
‘‘(2) any provider participating under a State 
plan under title XIX of such Act (42 U.S.C. 1396 
et seq.); 
‘‘(3) an Aging and Disability Resource Center, 
an area agency on aging, or a State agency (as de-
fined in section 102 of the Older Americans Act of 
1965 (42 U.S.C. 3002)); 
‘‘(4) a center for independent living (as defined 
in section 702 of the Rehabilitation Act of 1973 (29 
U.S.C. 796a)); or 
‘‘(5) any entity or provider not described in 
paragraph (1) or (2) of this subsection that the Sec-
retary determines to be eligible pursuant to the cer-
tification process described in subsection (c). 
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‘‘(c) ELIGIBLE ENTITY
OR PROVIDER CERTIFI-
CATION PROCESS.—The Secretary shall establish by regu-
lation a process for the certification of eligible entities or 
providers or recertification of eligible entities or providers 
under this section. Such a process shall, at a minimum— 
‘‘(1) establish deadlines for actions on applica-
tions for certification; 
‘‘(2) set forth standards for an approval or de-
nial of certification, duration of certification, revoca-
tion of an eligible entity or provider’s certification, 
and recertification of eligible entities or providers; 
‘‘(3) require the denial of certification if the 
Secretary determines the eligible entity or provider 
is excluded from participation in a Federal health 
care program under section 1128 or section 1128A 
of the Social Security Act (42 U.S.C. 1320a–7 or 
1320a–7a) or is currently identified as an excluded 
source on the System for Award Management Exclu-
sions list described in part 9 of title 48, Code of 
Federal Regulations, and part 180 of title 2 of such 
Code, or successor regulations; 
‘‘(4) establish procedures for screening eligible 
entities or providers according to the risk of fraud, 
waste, and abuse that are similar to the standards 
under section 1866(j)(2)(B) of the Social Security 
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Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 
of title 48, Code of Federal Regulations, or suc-
cessor regulations; and 
‘‘(5) incorporate and apply the restrictions and 
penalties set forth in chapter 21 of title 41 and treat 
this section as a procurement program only for pur-
poses of applying such provisions. 
‘‘(d) RATES.—To the extent practicable, the rates 
paid by the Secretary for hospital care, medical services, 
and extended care services provided under a Veterans 
Care Agreement shall be in accordance with the rates paid 
by the United States under section 1703(i) of this title. 
‘‘(e) TERMS OF VETERANS CARE AGREEMENTS.—(1) 
Pursuant to regulations promulgated under subsection 
(k), the Secretary may define the requirements for pro-
viders and entities entering into agreements under this 
section based upon such factors as the number of patients 
receiving care or services, the number of employees em-
ployed by the entity or provider furnishing such care or 
services, the amount paid by the Secretary to the provider 
or entity, or other factors as determined by the Secretary. 
‘‘(2) To furnish hospital care, medical services, or ex-
tended care services under this section, an eligible entity 
or provider shall agree— 
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‘‘(A) to accept payment at the rates established 
in regulations prescribed under this section; 
‘‘(B) that payment by the Secretary under this 
section on behalf of a veteran to a provider of serv-
ices or care shall, unless rejected and refunded by 
the provider within 30 days of receipt, constitute 
payment in full and extinguish any liability on the 
part of the veteran for the treatment or care pro-
vided, and no provision of a contract, agreement, or 
assignment to the contrary shall operate to modify, 
limit, or negate this requirement; 
‘‘(C) to provide only the care and services au-
thorized by the Department under this section and 
to obtain the prior written consent of the Depart-
ment to furnish care or services outside the scope of 
such authorization; 
‘‘(D) to bill the Department in accordance with 
the methodology outlined in regulations prescribed 
under this section; 
‘‘(E) to not seek to recover or collect from a 
health plan contract or third party, as those terms 
are defined in section 1729 of this title, for any care 
or service that is furnished or paid for by the De-
partment; 
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‘‘(F) to provide medical records to the Depart-
ment in the time frame and format specified by the 
Department; and 
‘‘(G) to meet such other terms and conditions, 
including quality of care assurance standards, as the 
Secretary may specify in regulation. 
‘‘(f) DISCONTINUATION OR NONRENEWAL OF A VET-
ERANS CARE AGREEMENT.—(1) An eligible entity or pro-
vider may discontinue a Veterans Care Agreement at such 
time and upon such notice to the Secretary as may be 
provided in regulations prescribed under this section. 
‘‘(2) The Secretary may discontinue a Veterans Care 
Agreement with an eligible entity or provider at such time 
and upon such reasonable notice to the eligible entity or 
provider as may be specified in regulations prescribed 
under this section, if an official designated by the Sec-
retary— 
‘‘(A) has determined that the eligible entity or 
provider failed to comply substantially with the pro-
visions of the Veterans Care Agreement, or with the 
provisions of this section or regulations prescribed 
under this section; 
‘‘(B) has determined the eligible entity or pro-
vider is excluded from participation in a Federal 
health care program under section 1128 or section 
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1128A of the Social Security Act (42 U.S.C. 1320a– 
7 or 1320a–7a) or is identified on the System for 
Award Management Exclusions list as provided in 
part 9 of title 48, Code of Federal Regulations, and 
part 180 of title 2 of such Code, or successor regula-
tions; 
‘‘(C) has ascertained that the eligible entity or 
provider has been convicted of a felony or other seri-
ous offense under Federal or State law and deter-
mines the eligible entity or provider’s continued par-
ticipation would be detrimental to the best interests 
of veterans or the Department; or 
‘‘(D) has determined that it is reasonable to 
terminate the agreement based on the health care 
needs of a veteran. 
‘‘(g) QUALITY OF CARE.—The Secretary shall estab-
lish a system or systems for monitoring the quality of care 
provided to veterans through Veterans Care Agreements 
and for assessing the quality of hospital care, medical 
services, and extended care services furnished by eligible 
entities and providers before the renewal of Veterans Care 
Agreements. 
‘‘(h) DISPUTES.—(1) The Secretary shall promulgate 
administrative procedures for eligible entities and pro-
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viders to present all disputes arising under or related to 
Veterans Care Agreements. 
‘‘(2) Such procedures constitute the eligible entities’ 
and providers’ exhaustive and exclusive administrative 
remedies. 
‘‘(3) Eligible entities or providers must first exhaust 
such administrative procedures before seeking any judicial 
review under section 1346 of title 28 (known as the ‘Tuck-
er Act’). 
‘‘(4) Disputes under this section must pertain to ei-
ther the scope of authorization under the Veterans Care 
Agreement or claims for payment subject to the Veterans 
Care Agreement and are not claims for the purposes of 
such laws that would otherwise require application of sec-
tions 7101 through 7109 of title 41, United States Code. 
‘‘(i) APPLICABILITY
OF
OTHER
PROVISIONS
OF 
LAW.—(1) A Veterans Care Agreement may be authorized 
by the Secretary or any Department official authorized by 
the Secretary, and such action shall not be treated as— 
‘‘(A) an award for the purposes of such laws 
that would otherwise require the use of competitive 
procedures for the furnishing of care and services; or 
‘‘(B) a Federal contract for the acquisition of 
goods or services for purposes of any provision of 
Federal law governing Federal contracts for the ac-
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quisition of goods or services except section 4706(d) 
of title 41. 
‘‘(2)(A) Except as provided in the agreement itself, 
in subparagraph (B), and unless otherwise provided in this 
section or regulations prescribed pursuant to this section, 
an eligible entity or provider that enters into an agreement 
under this section is not subject to, in the carrying out 
of the agreement, any law to which providers of services 
and suppliers under the Medicare program under title 
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) 
are not subject. 
‘‘(B) An eligible entity or provider that enters into 
an agreement under this section is subject to— 
‘‘(i) all laws regarding integrity, ethics, or 
fraud, or that subject a person to civil or criminal 
penalties; and 
‘‘(ii) all laws that protect against employment 
discrimination or that otherwise ensure equal em-
ployment opportunities. 
‘‘(3) Notwithstanding paragraph (2)(B)(i), an eligible 
entity or provider that enters into an agreement under this 
section shall not be treated as a Federal contractor or sub-
contractor for purposes of chapter 67 of title 41 (com-
monly known as the ‘McNamara-O’Hara Service Contract 
Act of 1965’). 
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‘‘(j) PARITY OF TREATMENT.—Eligibility for hospital 
care, medical services, and extended care services fur-
nished to any veteran pursuant to a Veterans Care Agree-
ment shall be subject to the same terms as though pro-
vided in a facility of the Department, and provisions of 
this chapter applicable to veterans receiving such care and 
services in a facility of the Department shall apply to vet-
erans treated under this section. 
‘‘(k) RULEMAKING.—The Secretary shall promulgate 
regulations to carry out this section.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item related to section 1703 the following new 
item: 
‘‘1703A. Agreements with eligible entities or providers; certification processes.’’. 
SEC. 103. CONFORMING AMENDMENTS FOR STATE VET-
ERANS HOMES. 
(a) IN GENERAL.—Section 1745(a) is amended— 
(1) in paragraph (1), by striking ‘‘(or agree-
ment under section 1720(c)(1) of this title)’’ and in-
serting ‘‘(or an agreement)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4)(A) An agreement under this section may be au-
thorized by the Secretary or any Department official au-
thorized by the Secretary, and any such action is not an 
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award for purposes of such laws that would otherwise re-
quire the use of competitive procedures for the furnishing 
of hospital care, medical services, and extended care serv-
ices. 
‘‘(B)(i) Except as provided in the agreement itself, 
in clause (ii), and unless otherwise provided in this section 
or regulations prescribed pursuant to this section, a State 
home that enters into an agreement under this section is 
not subject to, in the carrying out of the agreement, any 
provision of law to which providers of services and sup-
pliers under the Medicare program under title XVIII of 
the Social Security Act (42 U.S.C. 1395 et seq.) are not 
subject. 
‘‘(ii) A State home that enters into an agreement 
under this section is subject to— 
‘‘(I) all provisions of law regarding integrity, 
ethics, or fraud, or that subject a person to civil or 
criminal penalties; 
‘‘(II) all provisions of law that protect against 
employment discrimination or that otherwise ensure 
equal employment opportunities; and 
‘‘(III) all provisions in subchapter V of chapter 
17 of this title. 
‘‘(iii) Notwithstanding subparagraph (B)(ii)(I), a 
State home that enters into an agreement under this sec-
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tion may not be treated as a Federal contractor or subcon-
tractor for purposes of chapter 67 of title 41 (known as 
the ‘McNamara-O’Hara Service Contract Act of 1965’).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to care provided on or after the 
effective date of regulations issued by the Secretary of 
Veterans Affairs to carry out this section. 
SEC. 104. ACCESS STANDARDS AND STANDARDS FOR QUAL-
ITY. 
(a) IN GENERAL.—Subchapter I of chapter 17, as 
amended by section 102, is further amended by inserting 
after section 1703A the following new sections: 
‘‘§ 1703B. Access standards 
‘‘(a)(1) The Secretary shall establish access stand-
ards for furnishing hospital care, medical services, or ex-
tended care services to covered veterans for the purposes 
of section 1703(d). 
‘‘(2) The Secretary shall ensure that the access 
standards established under paragraph (1) define such 
categories of care to cover all care and services within the 
medical benefits package of the Department of Veterans 
Affairs. 
‘‘(b) The Secretary shall ensure that the access 
standards provide covered veterans, employees of the De-
partment, and health care providers in the network estab-
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lished under section 1703(h) with relevant comparative in-
formation that is clear, useful, and timely, so that covered 
veterans can make informed decisions regarding their 
health care. 
‘‘(c) The Secretary shall consult with all pertinent 
Federal entities (including the Department of Defense, the 
Department of Health and Human Services, and the Cen-
ters for Medicare & Medicaid Services), entities in the pri-
vate sector, and other nongovernmental entities in estab-
lishing access standards. 
‘‘(d)(1) Not later than 270 days after the date of the 
enactment of the Caring for Our Veterans Act of 2018, 
the Secretary shall submit to the appropriate committees 
of Congress a report detailing the access standards. 
‘‘(2)(A) Before submitting the report required under 
paragraph (1), the Secretary shall provide periodic up-
dates to the appropriate committees of Congress to con-
firm the Department’s progress towards developing the ac-
cess standards required by this section. 
‘‘(B) The first update under subparagraph (A) shall 
occur no later than 120 days from the date of the enact-
ment of the Caring for Our Veterans Act of 2018. 
‘‘(3) Not later than 540 days after the date on which 
the Secretary implements the access standards established 
under subsection (a), the Secretary shall submit to the ap-
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propriate committees of Congress a report detailing the 
implementation of and compliance with such access stand-
ards by Department and non-Department entities or pro-
viders. 
‘‘(e) Not later than three years after the date on 
which the Secretary establishes access standards under 
subsection (a) and not less frequently than once every 
three years thereafter, the Secretary shall— 
‘‘(1) conduct a review of such standards; and 
‘‘(2) submit to the appropriate committees of 
Congress a report on the findings and any modifica-
tion to the access standards with respect to the re-
view conducted under paragraph (1). 
‘‘(f) The Secretary shall ensure health care providers 
specified under section 1703(c) are able to comply with 
the applicable access standards established by the Sec-
retary. 
‘‘(g) The Secretary shall publish in the Federal Reg-
ister and on an internet website of the Department the 
designated access standards established under this section 
for purposes of section 1703(d)(1)(D). 
‘‘(h)(1) Consistent with paragraphs (1)(D) and (3) 
of section 1703(d), covered veterans may contact the De-
partment at any time to request a determination regarding 
whether they are eligible to receive care and services from 
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a non-Department entity or provider based on the Depart-
ment being unable to furnish such care and services in 
a manner that complies with the designated access stand-
ards established under this section. 
‘‘(2) The Secretary shall establish a process to review 
such requests from covered veterans to determine wheth-
er— 
‘‘(A) the requested care is clinically necessary; 
and 
‘‘(B) the Department is able to provide such 
care in a manner that complies with designated ac-
cess standards established under this section. 
‘‘(3) The Secretary shall promptly respond to any 
such request by a covered veteran. 
‘‘(i)(1) The term ‘appropriate committees of Con-
gress’ means— 
‘‘(A) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the Senate; and 
‘‘(B) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the House of 
Representatives. 
‘‘(2) The term ‘covered veterans’ refers to veterans 
described in section 1703(b) of this title. 
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‘‘§ 1703C. Standards for quality 
‘‘(a) IN GENERAL.—(1) The Secretary shall establish 
standards for quality regarding hospital care, medical 
services, and extended care services furnished by the De-
partment pursuant to this title, including through non-De-
partment health care providers pursuant to section 1703 
of this title. 
‘‘(2) In establishing standards for quality under para-
graph (1), the Secretary shall consider existing health 
quality measures that are applied to public and privately 
sponsored health care systems with the purpose of pro-
viding covered veterans relevant comparative information 
to make informed decisions regarding their health care. 
‘‘(3) The Secretary shall collect and consider data for 
purposes of establishing the standards under paragraph 
(1). Such data collection shall include— 
‘‘(A) after consultation with veterans service or-
ganizations and other key stakeholders on survey de-
velopment or modification of an existing survey, a 
survey of veterans who have used hospital care, med-
ical services, or extended care services furnished by 
the Veterans Health Administration during the most 
recent two-year period to assess the satisfaction of 
the veterans with service and quality of care; and 
‘‘(B) datasets that include, at a minimum, ele-
ments relating to the following: 
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‘‘(i) Timely care. 
‘‘(ii) Effective care. 
‘‘(iii) Safety, including, at a minimum, 
complications, readmissions, and deaths. 
‘‘(iv) Efficiency. 
‘‘(4) The Secretary shall consult with all pertinent 
Federal entities (including the Department of Defense, the 
Department of Health and Human Services, and the Cen-
ters for Medicare & Medicaid Services), entities in the pri-
vate sector, and other nongovernmental entities in estab-
lishing standards for quality. 
‘‘(5)(A) Not later than 270 days after the date of 
the enactment of the Caring for Our Veterans Act of 
2018, the Secretary shall submit to the appropriate com-
mittees of Congress a report detailing the standards for 
quality. 
‘‘(B)(i) Before submitting the report required under 
subparagraph (A), the Secretary shall provide periodic up-
dates to the appropriate committees of Congress to con-
firm the Department’s progress towards developing the 
standards for quality required by this section. 
‘‘(ii) The first update under clause (i) shall occur no 
later than 120 days from the date of the enactment of 
the Caring for Our Veterans Act of 2018. 
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‘‘(b) PUBLICATION AND CONSIDERATION OF PUBLIC 
COMMENTS.—(1) Not later than one year after the date 
on which the Secretary establishes standards for quality 
under subsection (a), the Secretary shall publish the qual-
ity rating of medical facilities of the Department in the 
publicly available Hospital Compare website through the 
Centers for Medicare & Medicaid Services for the purpose 
of providing veterans with information that allows them 
to compare performance measure information among De-
partment and non-Department health care providers. 
‘‘(2) Not later than two years after the date on which 
the Secretary establishes standards for quality under sub-
section (a), the Secretary shall consider and solicit public 
comment on potential changes to the measures used in 
such standards to ensure that they include the most up- 
to-date and applicable industry measures for veterans. 
‘‘(c)(1) The term ‘appropriate committees of Con-
gress’ means— 
‘‘(A) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the Senate; and 
‘‘(B) the Committee on Veterans’ Affairs and 
the Committee on Appropriations of the House of 
Representatives. 
‘‘(2) The term ‘covered veterans’ refers to veterans 
described in section 1703(b) of this title.’’. 
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