(1) IN GENERAL.—Subchapter I of chapter 17 
of title 38, United States Code is amended by insert-
ing after section 1703 the following new section: 
‘‘§ 1703A. Payment of non-Department health care 
providers 
‘‘(a) PROMPT PAYMENT COMPLIANCE.—The Sec-
retary shall ensure that payments made to non-Depart-
ment health care providers, including under the Veterans 
Choice Program established by section 101 of the Vet-
erans Access, Choice, and Accountability Act of 2014 
(Public Law 113–146; 38 U.S.C. 1701 note), comply with 
chapter 39 of title 31 (commonly referred to as the 
‘Prompt Payment Act’) and the requirements of this sec-
tion. If there is a conflict between the requirements of the 
Prompt Payment Act and the requirements of this section, 
the Secretary shall comply with the requirements of this 
section. 
‘‘(b) PAYMENT SCHEDULE.—(1) The Secretary shall 
reimburse a non-Department health care provider for care 
or services furnished under the laws administered by the 
Secretary— 
‘‘(A) in the case of a clean claim submitted to 
the Secretary electronically, not later than 30 days 
after receiving the claim; or 
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‘‘(B) in the case of a clean claim submitted to 
the Secretary in a manner other than electronically, 
not later than 45 days after receiving the claim. 
‘‘(2)(A) If the Secretary determines that a claim re-
ceived from a non-Department health care provider is a 
non-clean claim, the Secretary shall submit to the pro-
vider, not later than 10 days after receiving the claim— 
‘‘(i) a notification that the claim is a non-clean 
claim; 
‘‘(ii) an explanation of why the claim has been 
determined to be a non-clean claim; and 
‘‘(iii) an identification of the information or 
documentation that is required to make the claim a 
clean claim. 
‘‘(B) If the Secretary does not comply with the re-
quirements of subparagraph (A) with respect to a claim, 
the claim shall be deemed a clean claim for purposes of 
paragraph (1). 
‘‘(3) Upon receipt by the Secretary of information or 
documentation described in subparagraph (A)(iii) with re-
spect to a claim, the Secretary shall reimburse a non-De-
partment health care provider— 
‘‘(A) in the case of a claim submitted to the 
Secretary electronically, not later than 30 days after 
receiving such information or documentation; or 
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‘‘(B) in the case of claim submitted to the Sec-
retary in a manner other than electronically, not 
later than 45 days after receiving such information 
or documentation. 
‘‘(4) If the Secretary fails to comply with the dead-
lines for payment set forth in this subsection with respect 
to a claim, interest shall accrue on the amount owed under 
such claim in accordance with section 3902 of title 31. 
‘‘(c) INFORMATION
AND
DOCUMENTATION
RE-
QUIRED.—(1) Pursuant to regulations prescribed by the 
Secretary, the Secretary shall provide to non-Department 
health care providers that furnish hospital care or medical 
services to veterans pursuant to the laws administered by 
the Secretary information and documentation that is re-
quired to establish a clean claim under this section. 
‘‘(2) The Secretary shall consult with entities in the 
health care industry, in the public and private sector, to 
determine the information and documentation to include 
in the list under paragraph (1). 
‘‘(d) ELECTRONIC CLAIM SUBMITTAL.—On and after 
January 1, 2019, the Secretary shall not accept any claim 
under this section that is submitted to the Secretary in 
a manner other than electronically. 
‘‘(e) DEFINITIONS.—In this section: 
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‘‘(1) The term ‘clean claim’ means a claim for 
reimbursement for hospital care or medical services 
furnished by non-Department health care providers 
to veterans pursuant to the laws administered by the 
Secretary, on a nationally recognized standard for-
mat, that includes the information and documenta-
tion necessary to adjudicate the claim. 
‘‘(2) The term ‘non-clean claim’ means a claim 
for reimbursement for hospital care or medical serv-
ices furnished by non-Department health care pro-
viders to veterans pursuant to the laws administered 
by the Secretary, on a nationally recognized stand-
ard format, that does not include the information 
and documentation necessary to adjudicate the 
claim.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 17 of such title is 
amended by inserting after the item related to sec-
tion 1703 the following new item: 
‘‘1703A. Payment of non-Department health care providers.’’. 
(b) ELECTRONIC SUBMITTAL OF CLAIMS FOR REIM-
BURSEMENT.— 
(1) PROHIBITION
ON
ACCEPTANCE
OF
NON- 
ELECTRONIC CLAIMS.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), on and after January 1, 
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2019, the Secretary of Veterans Affairs shall 
not accept any claim for reimbursement under 
section 1703A of title 38, United States Code, 
as added by subsection (a), that is submitted to 
the Secretary in a manner other than electroni-
cally, including medical records in connection 
with such a claim. 
(B) EXCEPTION.—If the Secretary deter-
mines that accepting claims and medical 
records in a manner other than electronically is 
necessary for the timely processing of claims for 
reimbursement under such section 1703A due 
to a failure or malfunction of the electronic 
interface established under paragraph (2), the 
Secretary— 
(i) may accept claims and medical 
records in a manner other than electroni-
cally for a period not to exceed 90 days; 
and 
(ii) shall submit to the Committee on 
Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the 
House of Representatives a report setting 
forth— 
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(I) the reason for accepting 
claims and medical records in a man-
ner other than electronically; 
(II) the duration of time that the 
Department of Veterans Affairs will 
accept claims and medical records in a 
manner other than electronically; and 
(III) the steps that the Depart-
ment is taking to resolve such failure 
or malfunction. 
(2) ELECTRONIC INTERFACE.— 
(A) IN GENERAL.—Not later than January 
1, 2019, the Chief Information Officer of the 
Department of Veterans Affairs shall establish 
and make operational an electronic interface for 
health care providers to submit claims for reim-
bursement under such section 1703A. 
(B) FUNCTIONS.—The electronic interface 
established under subparagraph (A) shall in-
clude the following functions: 
(i) A function through which a health 
care provider may input all relevant data 
required for claims submittal and reim-
bursement. 
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(ii) A function through which a health 
care provider may upload medical records 
to accompany a claim for reimbursement. 
(iii) A function through which a 
health care provider may ascertain the sta-
tus of a pending claim for reimbursement 
that— 
(I) indicates whether the claim is 
a clean claim or a non-clean claim; 
and 
(II) in the event that a submitted 
claim is indicated as a non-clean 
claim, provides— 
(aa) an explanation of why 
the claim has been determined to 
be a non-clean claim; and 
(bb) an identification of the 
information 
or 
documentation 
that is required to make the 
claim a clean claim. 
(iv) A function through which a 
health care provider is notified when a 
claim for reimbursement is accepted or re-
jected. 
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(v) Such other features as the Sec-
retary considers necessary. 
(C) PROTECTION OF INFORMATION.— 
(i) 
IN
GENERAL.—The 
electronic 
interface established under subparagraph 
(A) shall be developed and implemented 
based on industry-accepted information se-
curity and privacy engineering principles 
and best practices and shall provide for the 
following: 
(I) The elicitation, analysis, and 
prioritization of functional and non-
functional information security and 
privacy requirements for such inter-
face, including specific security and 
privacy services and architectural re-
quirements relating to security and 
privacy based on a thorough analysis 
of all reasonably anticipated cyber and 
noncyber threats to the security and 
privacy of electronic protected health 
information made available through 
such interface. 
(II) The elicitation, analysis, and 
prioritization of secure development 
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requirements relating to such inter-
face. 
(III) The assurance that the 
prioritized information security and 
privacy requirements of such inter-
face— 
(aa) are correctly imple-
mented in the design and imple-
mentation 
of 
such 
interface 
throughout the system develop-
ment lifecycle; and 
(bb) satisfy the information 
objectives of such interface relat-
ing 
to 
security 
and 
privacy 
throughout the system develop-
ment lifecycle. 
(ii) DEFINITIONS.—In this subpara-
graph: 
(I) 
ELECTRONIC
PROTECTED 
HEALTH
INFORMATION.—The term 
‘‘electronic protected health informa-
tion’’ has the meaning given that term 
in section 160.103 of title 45, Code of 
Federal Regulations, as in effect on 
the date of the enactment of this Act. 
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(II) SECURE DEVELOPMENT RE-
QUIREMENTS.—The term ‘‘secure de-
velopment requirements’’ means, with 
respect to the electronic interface es-
tablished under subparagraph (A), ac-
tivities that are required to be com-
pleted during the system development 
lifecycle of such interface, such as se-
cure coding principles and test meth-
odologies. 
(3) ANALYSIS OF AVAILABLE TECHNOLOGY FOR 
ELECTRONIC INTERFACE.— 
(A) IN GENERAL.—Not later than January 
1, 2018, or before entering into a contract to 
procure or design and build the electronic inter-
face described in paragraph (2) or making a de-
cision to internally design and build such elec-
tronic interface, whichever occurs first, the Sec-
retary shall— 
(i) conduct an analysis of commer-
cially available technology that may satisfy 
the requirements of such electronic inter-
face set forth in such paragraph; and 
(ii) submit to the Committee on Vet-
erans’ Affairs of the Senate and the Com-
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mittee on Veterans’ Affairs of the House 
of Representatives a report setting forth 
such analysis. 
(B) 
ELEMENTS.—The 
report 
required 
under subparagraph (A)(ii) shall include the 
following: 
(i) An evaluation of commercially 
available systems that may satisfy the re-
quirements of paragraph (2). 
(ii) The estimated cost of procuring a 
commercially available system if a suitable 
commercially available system exists. 
(iii) If no suitable commercially avail-
able system exists, an assessment of the 
feasibility of modifying a commercially 
available system to meet the requirements 
of paragraph (2), including the estimated 
cost associated with such modifications. 
(iv) If no suitable commercially avail-
able system exists and modifying a com-
mercially available system is not feasible, 
an assessment of the estimated cost and 
time that would be required to contract 
with a commercial entity to design and 
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build an electronic interface that meets the 
requirements of paragraph (2). 
(v) If the Secretary determines that 
the Department has the capabilities re-
quired to design and build an electronic 
interface that meets the requirements of 
paragraph (2), an assessment of the esti-
mated cost and time that would be re-
quired to design and build such electronic 
interface. 
(vi) A description of the decision of 
the Secretary regarding how the Depart-
ment plans to establish the electronic inter-
face required under paragraph (2) and the 
justification of the Secretary for such deci-
sion. 
(4) LIMITATION
ON
USE
OF
AMOUNTS.—The 
Secretary may not spend any amounts to procure or 
design and build the electronic interface described in 
paragraph (2) until the date that is 60 days after 
the date on which the Secretary submits the report 
required under paragraph (3)(A)(iii). 
(c) CLARIFICATION
OF APPLICATION
OF HIPAA 
TRANSACTION STANDARDS TO VETERANS CHOICE PRO-
GRAM AND OTHER VETERANS HEALTH CARE PROGRAMS 
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USING
NON-DEPARTMENT
PROVIDERS; ADDRESSING 
MULTI-YEAR BACKLOG IN CLAIMS.— 
(1) APPLICATION
OF
HIPAA
ADMINISTRATIVE 
SIMPLIFICATION STANDARDS.— 
(A) IN GENERAL.—The definition of the 
term ‘‘health plan’’ under section 1171(5)(J) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1320d(5)(J)) is deemed to include the Veterans 
Choice Program. 
(B) IMPLEMENTATION.—Not later than 90 
days after the date of the enactment of this 
Act, the Secretary of Veterans Affairs shall 
make such modifications as may be necessary to 
implement the amendment made by subpara-
graph (A) with respect to claims for hospital 
care or medical treatment furnished under the 
Veterans Choice Program. 
(2) ADDRESSING BACKLOG OF CLAIMS BY NON- 
DEPARTMENT PROVIDERS.— 
(A) ADJUDICATION.—Not later than 180 
days after the date of the enactment of this sec-
tion, the Secretary shall adjudicate all claims 
submitted before such date of enactment by 
non-Department of Veterans Affairs health care 
provider under the Veterans Choice Program. 
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(B) USE
OF
PAYMENT
SCHEDULE
FOR 
NON-DEPARTMENT
HEALTH
CARE
PRO-
VIDERS.—Section 1703A(b) of title 38, United 
States Code, as added by subsection (a)(1), 
shall apply to claims adjudicated pursuant to 
subparagraph (A), except that the timeframe 
involved shall begin on the date of such adju-
dication. 
(3) VETERANS CHOICE PROGRAM DEFINED.—In 
this subsection, the term ‘‘Veterans Choice Pro-
gram’’ means hospital care or medical treatment 
furnished to veterans pursuant to section 101 of the 
Veterans Access, Choice, and Accountability Act of 
2014 (Public Law 113–146; 38 U.S.C. 1701 note) 
or any other law administered by the Secretary of 
Veterans Affairs under which a non-Department of 
Veterans Affairs health care provider furnishes such 
care or services. 
Æ 
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