I 
114TH CONGRESS 
1ST SESSION H. R. 4103 
To amend title 38, United States Code, to improve the provision of medical 
care to veterans at critical access hospitals. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 19, 2015 
Mr. CRAMER introduced the following bill; which was referred to the Com-
mittee on Veterans’ Affairs, and in addition to the Committee on Ways 
and Means, for a period to be subsequently determined by the Speaker, 
in each case for consideration of such provisions as fall within the juris-
diction of the committee concerned 
A BILL 
To amend title 38, United States Code, to improve the 
provision of medical care to veterans at critical access 
hospitals. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Critical Access Hos-
pitals for Veterans Act’’ or the ‘‘CAHV Act’’. 
SEC. 2. CARE TO VETERANS AT CRITICAL ACCESS HOS-
PITALS. 
(a) AGREEMENT BETWEEN HHS AND VA.— 
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(1) IN
GENERAL.—Chapter 17 of title 38, 
United States Code, is amended by inserting after 
section 1703 the following new section: 
‘‘§ 1703A. Care at critical access hospitals 
‘‘(a) FURNISHING OF CARE.—At the election of a vet-
eran enrolled in the health care system established under 
section 1705(a) of this title, hospital care and medical 
services shall be furnished at critical access hospitals to 
the veteran pursuant to the agreement described in sub-
section (b)(1). 
‘‘(b) AGREEMENT.—(1) The agreement described in 
this paragraph is an agreement entered into by the Sec-
retary of Veterans Affairs and the Secretary of Health and 
Human Services under which— 
‘‘(A) the Secretary of Health and Human Serv-
ices, acting through the Centers for Medicare & 
Medicaid Services, shall, notwithstanding any other 
provision of law— 
‘‘(i) ensure that a critical access hospital 
may submit claims to the Centers for Medicare 
& Medicaid Services for hospital care and med-
ical services that are inpatient critical access 
hospital services and outpatient critical access 
hospital services (as such terms are defined in 
paragraphs (2) and (3), respectively, of section 
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1861(mm) of the Social Security Act (42 
U.S.C. 1395x(mm))) furnished to a veteran 
under subsection (a); and 
‘‘(ii) subject to paragraphs (2) and (3), 
provide payment to such critical access hospital 
for such services furnished to such veteran in 
the same manner and at 100 percent of the 
payment rate as would otherwise be made to 
such critical access hospital (including any cost- 
sharing obligation that would otherwise apply) 
if such services were furnished to an individual 
entitled to benefits under part A of title XVIII 
of the Social Security Act or enrolled under 
part B of such Act, as applicable; and 
‘‘(B) not later than 30 days after the Secretary 
of Health and Human Services provides such pay-
ment to such critical access hospital, the Secretary 
of Veterans Affairs shall reimburse the Secretary of 
Health and Human Services an amount equal to— 
‘‘(i) the payment provided to the critical 
access hospital pursuant to subparagraph (A) 
with respect to such services described in such 
subparagraph furnished to such veteran, minus 
‘‘(ii) any portion of such payment for such 
services furnished to such veteran for which 
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payment would otherwise be made under title 
XVIII of such Act (including any cost-sharing 
obligation that would otherwise apply) with re-
spect to such veteran, without application of 
this subsection, and which would not otherwise 
be provided pursuant to this chapter. 
‘‘(2) In the case of care or services furnished to a 
veteran by a critical access hospital for which payment 
would not be made under title XVIII of the Social Security 
Act if such veteran were an individual entitled to benefits 
under part A of such title or enrolled under part B, as 
applicable, the Secretary of Veterans Affairs and the Sec-
retary of Health and Human Services shall jointly deter-
mine the payment to be made under paragraph (1)(A) to 
such critical access hospital for such care or services fur-
nished to such veteran. Subparagraphs (A)(i) and (B) of 
paragraph (1) shall apply with respect to such care and 
services and any payments made pursuant to the previous 
sentence, respectively, in the same manner as such sub-
paragraphs apply to services described in and payments 
made under subparagraph (A)(ii) of such paragraph. 
‘‘(3) In the case of services described in paragraph 
(1)(B)(ii) furnished to a veteran for which payment would 
otherwise be made under title XVIII of the Social Security 
Act, any cost-sharing obligation otherwise applicable to 
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such veteran under such title with respect to such services 
shall apply. 
‘‘(c) ELIGIBILITY.—A veteran shall be eligible for the 
hospital care and medical services furnished under sub-
section (a) if the veteran presents to a critical access hos-
pital and provides the critical access hospital with any doc-
ument issued by the Department of Veterans Affairs that 
describes the enrollment of the veteran in the health care 
system established under section 1705(a) of this title, in-
cluding an identification card described in section 5706(f) 
of this title or a Veterans Choice Card described in section 
101(f) of the Veterans Access, Choice, and Accountability 
Act of 2014 (38 U.S.C. 1701 note). 
‘‘(d) CARE PROVIDED.—The hospital care and med-
ical services furnished to a veteran under subsection (a) 
shall be the care or services the eligible veteran is eligible 
to receive under this chapter. 
‘‘(e) MEDICAL RECORDS.—The Secretary of Veterans 
Affairs shall provide to a critical access hospital the med-
ical records of a veteran being treated by such hospital 
if such hospital requests such records. To the extent prac-
ticable, the Secretary shall provide such records electroni-
cally. 
‘‘(f) COSTS
TO VETERANS.—Any copayments or 
other charges that the Secretary may collect from a vet-
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eran or third party pursuant to this chapter for hospital 
care or medical services furnished to a veteran at a non- 
Department facility shall apply to care or services fur-
nished to the veteran under subsection (a). 
‘‘(g) REPORTS.—During the five-year period begin-
ning on the date of the enactment of this section, and from 
time to time thereafter, the Secretary of Veterans Affairs, 
in consultation with the Secretary of Health and Human 
Services, shall submit to the Committees on Veterans’ Af-
fairs and Energy and Commerce of the House of Rep-
resentatives and the Committees on Veteran’s Affairs and 
Health, Education, Labor, and Pensions of the Senate an 
annual report on the hospital care and medical services 
furnished under subsection (a). Each such report shall ex-
plain how furnishing such care and services under sub-
section (a) affects the following: 
‘‘(1) The resources of the Department of Vet-
erans Affairs. 
‘‘(2) The costs incurred by veterans to receive 
such care and services. 
‘‘(3) The amount of time a veteran must wait 
to receive hospital care and services. 
‘‘(h) CRITICAL ACCESS HOSPITAL DEFINED.—In 
this section, the term ‘critical access hospital’ means a 
hospital designated or certified as a critical access hospital 
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pursuant to section 1820 of the Social Security Act (42 
U.S.C. 1395i–4).’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of such chapter is amended 
by inserting after the item relating to section 1703 
the following new item: 
‘‘1703A. Care at critical access hospitals.’’. 
(b) MEDICARE CONDITION OF PARTICIPATION.—Sec-
tion 1820(e) of the Social Security Act (42 U.S.C. 1395i– 
4(e)) is amended— 
(1) in paragraph (2), by striking at the end 
‘‘and’’; 
(2) by redesignating paragraph (3) as para-
graph (4); and 
(3) by inserting after paragraph (2) the fol-
lowing new paragraph: 
‘‘(3) agrees to furnish items and services to vet-
erans in accordance with the agreement entered into 
between the Secretary and the Secretary of Veterans 
Affairs under section 1703A of title 38, United 
States Code; and’’. 
Æ 
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