I 
115TH CONGRESS 
1ST SESSION H. R. 4242 
To amend title 38, United States Code, to establish a permanent VA Care 
in the Community Program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 3, 2017 
Mr. ROE of Tennessee (for himself, Mr. COFFMAN, Mr. WENSTRUP, Mrs. 
RADEWAGEN, Mr. BOST, Mr. POLIQUIN, Mr. ARRINGTON, Mr. RUTHER-
FORD, Mr. HIGGINS of Louisiana, Mr. BERGMAN, Mr. BANKS of Indiana, 
Miss GONZA´LEZ-COLO´N of Puerto Rico, Mr. BILIRAKIS, Mr. DUNN, Mr. 
WALZ, Ms. KUSTER of New Hampshire, Miss RICE of New York, Mr. 
CORREA, Mr. SABLAN, Ms. ESTY of Connecticut, Mr. PETERS, Mr. 
O’ROURKE, Mr. TAKANO, and Ms. BROWNLEY of California) introduced 
the following bill; which was referred to the Committee on Veterans’ Af-
fairs 
A BILL 
To amend title 38, United States Code, to establish a perma-
nent VA Care in the Community Program, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘VA Care in the Community Act’’. 
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(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—IMPROVED ACCESS FOR VETERANS TO NON- 
DEPARTMENT OF VETERANS AFFAIRS MEDICAL CARE 
Sec. 101. Assignment of veterans to primary care providers. 
Sec. 102. Establishment of VA Care in the Community Program. 
Sec. 103. Veterans Care Agreements. 
Sec. 104. Modification of authority to enter into agreements with State homes 
to provide nursing home care. 
Sec. 105. Department of Veterans Affairs electronic interface for processing of 
medical claims. 
Sec. 106. Funding for VA Care in the Community Program. 
Sec. 107. Termination of certain provisions authorizing medical care to vet-
erans through non-Department of Veterans Affairs providers. 
Sec. 108. Implementation and transition. 
TITLE II—OTHER ADMINISTRATIVE MATTERS 
Sec. 201. Reimbursement for emergency ambulance services. 
Sec. 202. Improvement of care coordination for veterans through exchange of 
certain medical records. 
Sec. 203. Elimination of copayment offset. 
Sec. 204. Use of Department of Veterans Affairs Medical Care Collections 
Fund for certain improvements in collections. 
Sec. 205. Department of Veterans Affairs health care productivity improve-
ment. 
Sec. 206. Licensure of health care professionals of the Department of Veterans 
Affairs providing treatment via telemedicine. 
TITLE 
I—IMPROVED 
ACCESS 
FOR VETERANS TO NON-DE-
PARTMENT OF VETERANS AF-
FAIRS MEDICAL CARE 
SEC. 101. ASSIGNMENT OF VETERANS TO PRIMARY CARE 
PROVIDERS. 
Section 1706 of title 38, United States Code, is 
amended by adding at the end the following new sub-
section: 
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‘‘(d)(1) Except as provided in section 1703A of this 
title, in furnishing primary care under this chapter, the 
Secretary shall assign each eligible veteran to— 
‘‘(A) a patient-aligned care team of the Depart-
ment; or 
‘‘(B) a dedicated primary care provider of the 
Department as a part of any other model of pro-
viding consistent primary care determined appro-
priate by the Secretary. 
‘‘(2) Each patient-aligned care team of the Depart-
ment shall consist of a team of health care professionals 
of the Department who— 
‘‘(A) provide to each eligible veteran com-
prehensive primary care in partnership with the vet-
eran; and 
‘‘(B) manage and coordinate comprehensive 
hospital care and medical services consistent with 
the goals of care agreed upon by the veteran and 
team. 
‘‘(3) The Secretary shall ensure that an eligible vet-
eran is not simultaneously assigned to more than one pa-
tient-aligned care team or dedicated primary care provider 
under this subsection at a single location, including by es-
tablishing procedures in the event a primary care provider 
retires or is otherwise no longer able to treat the veteran. 
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In the case of an eligible veteran who resides in more than 
one location, the Secretary may assign such veteran to a 
patient-aligned care team or dedicated primary care pro-
vider at each such location. 
‘‘(4) The term ‘eligible veteran’ means a veteran 
who— 
‘‘(A) is enrolled in the patient enrollment sys-
tem of the Department established and operated 
under section 1705(a) of this title; and 
‘‘(B) has— 
‘‘(i) been furnished hospital care or med-
ical services at or through a Department facility 
on at least one occasion during the two-year pe-
riod preceding the date of the determination of 
eligibility; or 
‘‘(ii) requested a first-time appointment for 
hospital care or medical services at a Depart-
ment facility.’’. 
SEC. 102. ESTABLISHMENT OF VA CARE IN THE COMMU-
NITY PROGRAM. 
(a) ESTABLISHMENT OF PROGRAM.— 
(1) IN
GENERAL.—Chapter 17 of title 38, 
United States Code, is amended by inserting after 
section 1703 the following new section: 
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‘‘§ 1703A. VA Care in the Community Program 
‘‘(a) PROGRAM.—(1) Subject to the availability of ap-
propriations for such purpose, hospital care, medical serv-
ices, and extended care services under this chapter shall 
be furnished to an eligible veteran through contracts or 
agreements authorized under subsection (d), or contracts 
or agreements, including national contracts or agree-
ments, authorized under section 8153 of this title or any 
other provision of law administered by the Secretary, with 
network providers for the furnishing of such care and serv-
ices to veterans. 
‘‘(2) Subject to subsection (b), an eligible veteran 
may select a provider of such care or services from among 
network providers. 
‘‘(3) The Secretary shall coordinate the furnishing of 
care and services under this section to eligible veterans. 
‘‘(4)(A) In carrying out this section, the Secretary 
shall establish regional networks of network providers. 
The Secretary shall determine, and may modify, such re-
gions based on the capacity and market assessments of 
Veterans Integrated Service Networks conducted under 
subsection (k) or upon recognized need. 
‘‘(B) The Secretary may enter into one or more con-
tracts for the purposes of managing the operations of the 
regional networks and for the delivery of care pursuant 
to this section. 
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‘‘(b) PRIMARY AND SPECIALTY CARE.—(1)(A) If the 
Secretary is unable to assign an eligible veteran to a pa-
tient-aligned care team or dedicated primary care provider 
under section 1706(d) of this title because the Secretary 
determines such a care team or provider at a Department 
facility is not available— 
‘‘(i) the Secretary shall consult with the veteran 
regarding available primary care providers from 
among network providers that are located in the re-
gional network in which the veteran resides or a re-
gional network that is adjacent to the regional net-
work in which the veteran resides; and 
‘‘(ii) the veteran may select one of the available 
primary care providers to serve as the dedicated pri-
mary care provider of the veteran. 
‘‘(B) In determining whether a patient-aligned care 
team or dedicated provider under section 1706(d) of this 
title is available for assignment to a veteran, the Secretary 
shall take into consideration each of the following: 
‘‘(i) Whether the veteran faces an unusual or 
excessive burden in accessing such patient-aligned 
care team or dedicated provider at a medical facility 
of the Department including with respect to— 
‘‘(I) geographical challenges; 
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Secretary shall reevaluate such assignment not earlier 
than one year after a veteran makes a selection under sub-
paragraph (A)(ii), and on an annual basis thereafter, to— 
‘‘(i) determine whether the Secretary is able to 
assign to the veteran a patient-aligned care team or 
dedicated primary care provider under section 
1706(d) of this title; and 
‘‘(ii) in consultation with and upon approval of 
the veteran, make such assignment if able. 
‘‘(2)(A)(i) Except as provided in clause (ii), the Sec-
retary may only furnish specialty hospital care, medical 
services, or extended care services to an eligible veteran 
under this section pursuant to a referral for such specialty 
care or services made by the primary care provider of the 
veteran. 
‘‘(ii) The Secretary may designate specialties which 
shall be exempt from the requirement under clause (i). 
‘‘(B) The Secretary shall determine whether to fur-
nish specialty hospital care, medical services, or extended 
care services to an eligible veteran pursuant to subpara-
graph (A)— 
‘‘(i) at a medical facility of the Department 
that is within a reasonable distance of the residence 
of the veteran, as determined by the Secretary; 
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‘‘(ii) by a network provider that, to the greatest 
extent practicable, is located in the regional network 
in which the veteran resides or a regional network 
that is adjacent to the regional network in which the 
veteran resides; or 
‘‘(iii) pursuant to an agreement described in 
subparagraph (C). 
‘‘(C) An agreement described in this subparagraph 
is an agreement entered into by the Secretary with a net-
work provider under which— 
‘‘(i) specialty hospital care, medical services, or 
extended care services are furnished to an eligible 
veteran pursuant to subparagraph (A)— 
‘‘(I) at a medical facility of the Depart-
ment by a network provider possessing the ap-
propriate credentials, as determined by the Sec-
retary; or 
‘‘(II) at a facility of a network provider by 
a health care provider of the Department; and 
‘‘(ii) such specialty care or services are so fur-
nished either— 
‘‘(I) in accordance with this section with 
respect to fees and payments for care and serv-
ices furnished under subsection (a); or 
‘‘(II) at no cost to the United States. 
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‘‘(D) In making the determination under subpara-
graph (B), the Secretary shall give priority to medical fa-
cilities and health care providers of the Department but 
shall take into account— 
‘‘(i) whether the veteran faces an unusual or ex-
cessive burden in accessing such specialty hospital 
care, medical services, or extended care services at 
a medical facility of the Department, including with 
respect to— 
‘‘(I) geographical challenges; 
‘‘(II) environmental factors, such as roads 
that are not accessible to the general public, 
traffic, or hazardous weather; 
‘‘(III) a medical condition of the veteran; 
or 
‘‘(IV) such other factors as determined by 
the Secretary; and 
‘‘(ii) whether the primary care provider of the 
veteran recommends that such specialty hospital 
care, medical services, or extended care services 
should be furnished by a network provider. 
‘‘(E) The Secretary shall ensure that each medical 
facility of the Department processes referrals for specialty 
hospital care, medical services, or extended care services 
in a standardized manner, including with respect to the 
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organization of the program office responsible for such re-
ferrals. 
‘‘(F) In carrying out this section, the Secretary shall 
establish a process to review any disagreement between an 
eligible veteran and the Department, or between an eligi-
ble veteran and a health care provider of the Department, 
regarding the eligibility of the veteran to receive care or 
services from a network provider under this section or the 
assignment of a primary care provider of the Department 
to the veteran. In reviewing a disagreement under such 
process with respect to the availability of and assignment 
to a patient aligned care team or dedicated primary care 
provider, the Secretary shall give deference to the veteran 
with respect to any determination under subsection 
(b)(1)(B)(ii). 
‘‘(c) EPISODES OF CARE.—(1) The Secretary shall 
ensure that, at the election of an eligible veteran who re-
ceives hospital care, medical services, or extended care 
services from a network provider in an episode of care 
under this section, the veteran receives such care or serv-
ices from that network provider, another network provider 
selected by the veteran, or a health care provider of the 
Department, through the completion of the episode of 
care, including all specialty and ancillary services deter-
mined necessary by the provider as part of the treatment 
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recommended in the course of such care or services. In 
making such determination with respect to necessary spe-
cialty and ancillary services provided by a network pro-
vider, the network provider shall consult with the Sec-
retary, acting through the program office of the appro-
priate medical facility. 
‘‘(2) In cases of episodes of care that the Secretary 
determines case management to be appropriate, the Sec-
retary shall provide case management to an eligible vet-
eran who receives hospital care, medical services, or ex-
tended care services from a network provider for such epi-
sodes of care. The Secretary may provide such case man-
agement through the Veterans Health Administration or 
through an entity that manages the operations of the re-
gional networks pursuant to subsection (a)(4)(B). 
‘‘(d) CARE
AND SERVICES THROUGH CONTRACTS 
AND AGREEMENTS.—(1) The Secretary shall enter into 
contracts or agreements, including national contracts or 
agreements for, but not limited to, dialysis, for furnishing 
care and services to eligible veterans under this section 
with network providers. 
‘‘(2)(A) In entering into a contract or agreement 
under paragraph (1) with a network provider, the Sec-
retary shall— 
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‘‘(i) negotiate rates for the furnishing of care 
and services under this section; and 
‘‘(ii) reimburse the provider for such care and 
services at the rates negotiated pursuant to clause 
(i) as provided in such contract or agreement. 
‘‘(B)(i) Except as provided in paragraph (3), rates 
negotiated under subparagraph (A)(i) shall not be more 
than the rates paid by the United States to a provider 
of services (as defined in section 1861(u) of the Social Se-
curity Act (42 U.S.C. 1395x(u))) or a supplier (as defined 
in section 1861(d) of such Act (42 U.S.C. 1395x(d))) 
under the Medicare Program under title XVIII of the So-
cial Security Act (42 U.S.C. 1395 et seq.) for the same 
care or services. 
‘‘(ii) In determining the rates under the Medicare 
Program under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.) for purposes of clause (i), in the case 
of care or services furnished by a provider of services with 
respect to which such rates are determined under a fee 
schedule to which the area wage index under section 
1886(d)(3)(E) of the Social Security Act (42 U.S.C. 
1395ww(d)(3)(E)) applies, such area wage index so ap-
plied to such provider of services may not be less than 
1.00. 
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‘‘(C) In carrying out paragraph (2), the Secretary 
may incorporate the use of value-based reimbursement 
models to promote the provision of high-quality care. 
‘‘(3)(A) With respect to the furnishing of care or 
services under this section to an eligible veteran who re-
sides in a highly rural area (as defined under the rural- 
urban commuting area codes developed by the Secretary 
of Agriculture and the Secretary of Health and Human 
Services), the Secretary of Veterans Affairs may negotiate 
a rate that is more than the rate paid by the United States 
as described in paragraph (2)(B). 
‘‘(B) With respect to furnishing care or services 
under this section in Alaska, the Alaska Fee Schedule of 
the Department of Veterans Affairs will be followed, ex-
cept for when another payment agreement, including a 
contract or provider agreement, is in place. 
‘‘(C) With respect to furnishing care or services 
under this section in a State with an All-Payer Model 
Agreement under the Social Security Act that became ef-
fective on or after January 1, 2014, the Medicare payment 
rates under paragraph (2)(B) shall be calculated based on 
the payment rates under such agreement, or any such suc-
cessor agreement. 
‘‘(D) With respect to furnishing care or services 
under this section in a location in which the Secretary de-
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termines that adjusting the rate paid by the United States 
as described in paragraph (2)(B) is appropriate, the Sec-
retary may negotiate such an adjusted rate. 
‘‘(E) With respect to furnishing care or services 
under this section in a location or in a situation in which 
an exception to the rates paid by the United States under 
the Medicare Program under title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.) for the same care or 
services applies, the Secretary may follow such exception. 
‘‘(F) With respect to furnishing care or services 
under this section for care or services not covered under 
the Medicare Program under title XVIII of the Social Se-
curity Act (42 U.S.C. 1395 et seq.), the Secretary shall 
establish a schedule of fees for such care or services. 
‘‘(G) With respect to furnishing care or services 
under this section pursuant to an agreement with a tribal 
or Federal entity, the Secretary may negotiate a rate that 
is more than the rate paid by the United States as de-
scribed in paragraph (2)(B). 
‘‘(4) For the furnishing of care or services pursuant 
to a contract or agreement under paragraph (1), a net-
work provider may not collect any amount that is greater 
than the rate negotiated pursuant to paragraph (2)(A). 
‘‘(5)(A) If, in the course of an episode of care under 
this section, any part of care or services is furnished by 
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a medical provider who is not a network provider, the Sec-
retary may compensate such provider for furnishing such 
care or services. 
‘‘(B) The Secretary shall make reasonable efforts to 
enter into a contract or agreement under this section with 
any provider who is compensated pursuant to subpara-
graph (A). 
‘‘(e) PROMPT PAYMENT STANDARD.—(1) The Sec-
retary shall ensure that claims for payments for hospital 
care, medical services, or extended care services furnished 
under this section are processed in accordance with this 
subsection, regardless of whether such claims are— 
‘‘(A) made by a network provider to the Sec-
retary; 
‘‘(B) made by a network provider to a regional 
network operated by a contractor pursuant to sub-
section (a)(4)(B); or 
‘‘(C) made by such a regional network to the 
Secretary. 
‘‘(2) A covered claimant that seeks payment for hos-
pital care, medical services, or extended care services fur-
nished under this section shall submit to the covered payer 
a claim for payment not later than— 
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‘‘(A) with respect to a claim by a network pro-
vider, 180 days after the date on which the network 
provider furnishes such care or services; or 
‘‘(B) with respect to a claim by a regional net-
work operated by a contractor, 180 days after the 
date on which the contractor pays the network pro-
vider for furnishing such care or services. 
‘‘(3) Notwithstanding chapter 39 of title 31 or any 
other provision of law, the covered payer shall pay a cov-
ered claimant for hospital care, medical services, or ex-
tended care services furnished under this section— 
‘‘(A) in the case of a clean claim submitted to 
the covered payer on paper, not later than 45 cal-
endar days after receiving the claim; or 
‘‘(B) in the case of a clean claim submitted to 
the covered payer electronically, not later than 30 
calendar days after receiving the claim. 
‘‘(4)(A) If the covered payer denies a claim submitted 
by a covered claimant under paragraph (1), the covered 
payer shall notify the covered claimant of the reason for 
denying the claim and the additional information, if any, 
that may be required to process the claim— 
‘‘(i) in the case of a clean claim submitted to 
the covered payer on paper, not later than 45 cal-
endar days after receiving the claim; or 
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‘‘(ii) in the case of a clean claim submitted to 
the covered payer electronically, not later than 30 
calendar days after receiving the claim. 
‘‘(B) Upon receipt by the covered payer of additional 
information specified under subparagraph (A) relating to 
a claim, the covered payer shall pay, deny, or otherwise 
adjudicate the claim, as appropriate, not later than 30 cal-
endar days after receiving such information. 
‘‘(5)(A) If the covered payer has not paid a covered 
claimant or denied a clean claim for payment by the cov-
ered claimant under this subsection during the appro-
priate period specified in this subsection, such clean claim 
shall be considered overdue. 
‘‘(B) If a clean claim for payment by a covered claim-
ant is considered overdue under subparagraph (A), in ad-
dition to the amount the covered payer owes the covered 
claimant under the claim, the covered payer shall owe the 
covered claimant an interest penalty amount that shall— 
‘‘(i) be prorated daily; 
‘‘(ii) accrue from the date the payment was 
overdue; 
‘‘(iii) be payable at the time the claim is paid; 
and 
‘‘(iv) be computed at the rate of interest estab-
lished by the Secretary of the Treasury, and pub-
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lished in the Federal Register, for interest payments 
under subsections (a)(1) and (b) of section 7109 of 
title 41 that is in effect at the time the covered 
payer accrues the obligation to pay the interest pen-
alty amount. 
‘‘(6)(A) If the covered payer overpays a covered 
claimant for hospital care, medical services, or extended 
care services furnished under this section— 
‘‘(i) the covered payer shall deduct the amount 
of any overpayment from payments due to the cov-
ered claimant after the date of such overpayment; or 
‘‘(ii) if the covered payer determines that there 
are no such payments due after the date of the over-
payment, the covered claimant shall refund the 
amount of such overpayment not later than 30 days 
after such determination. 
‘‘(B)(i) Before deducting any amount from a pay-
ment to a covered claimant under subparagraph (A), the 
covered payer shall ensure that the covered claimant is 
provided an opportunity— 
‘‘(I) to dispute the existence or amount of any 
overpayment owed to the covered payer; and 
‘‘(II) to request a compromise with respect to 
any such overpayment. 
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‘‘(ii) The covered payer may not make any deduction 
from a payment to a covered claimant under subparagraph 
(A) unless the covered payer has made reasonable efforts 
to notify the covered claimant of the rights of the covered 
claimant under subclauses (I) and (II) of clause (i). 
‘‘(iii) Upon receiving a dispute under subclause (I) 
of clause (i) or a request under subclause (II) of such 
clause, the covered payer shall make a determination with 
respect to such dispute or request before making any de-
duction under subparagraph (A) unless the time required 
to make such a determination would jeopardize the ability 
of the covered payer to recover the full amount owed to 
the covered payer. 
‘‘(7) Notwithstanding any other provision of law, the 
Secretary may, except in the case of a fraudulent claim, 
false claim, or misrepresented claim, compromise any 
claim of an amount owed to the United States under this 
section. 
‘‘(8) This subsection shall apply only to payments 
made on a claims basis and not to capitation or other 
forms of periodic payments to network providers. 
‘‘(9) A network provider that provides hospital care, 
medical services, or extended care services to an eligible 
veteran under this section may not seek any payment for 
such care or services from the eligible veteran. 
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‘‘(10) With respect to making a payment for hospital 
care or medical services furnished to an eligible veteran 
by a network provider under this section— 
‘‘(A) the Secretary may not require receipt by 
the veteran or the Department of a medical record 
under subsection (g) detailing such care or services 
before a covered payer makes a payment for such 
care or services; and 
‘‘(B) the Secretary may require that the net-
work provider attests to such care or services so pro-
vided before a covered payer makes a payment for 
such care or services. 
‘‘(f) COST-SHARING.—(1) The Secretary shall require 
an eligible veteran to pay a copayment for the receipt of 
care or services under this section only if such eligible vet-
eran would be required to pay a copayment for the receipt 
of such care or services at a medical facility of the Depart-
ment or from a health care provider of the Department 
under this chapter. 
‘‘(2) The amount of a copayment charged under 
paragraph (1) may not exceed the amount of the copay-
ment that would be payable by such eligible veteran for 
the receipt of such care or services at a medical facility 
of the Department or from a health care provider of the 
Department under this chapter. 
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‘‘(3) In any case in which an eligible veteran is fur-
nished hospital care or medical services under this section 
for a non-service-connected disability described in sub-
section (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 contract described in section 
1705A in accordance with such section 1729. 
‘‘(g) MEDICAL RECORDS.—(1) The Secretary shall 
ensure that any network provider that furnishes care or 
services under this section to an eligible veteran— 
‘‘(A) upon the request of the veteran, provides 
to the veteran the medical records related to such 
care or services; and 
‘‘(B) upon the completion of the provision of 
such care or services to such veteran, provides to the 
Department the medical records for the veteran fur-
nished care or services under this section in a time-
frame and format specified by the Secretary for pur-
poses of this section, except the Secretary may not 
require that any payment by the Secretary to the eli-
gible provider be contingent on such provision of 
medical records. 
‘‘(2) To the extent practicable, the Secretary shall 
submit to a network provider that furnishes care or serv-
ices under this section to an eligible veteran the medical 
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records of such eligible veteran that are maintained by the 
Department and are relevant to such care or services. 
‘‘(3) To the extent practicable, the Secretary shall— 
‘‘(A) ensure that the medical records shared 
under paragraphs (1) and (2) are shared in an elec-
tronic format accessible by network providers and 
the Department through an Internet website; and 
‘‘(B) provide to network providers access to the 
electronic patient health record system of the De-
partment, or successor system, for the purpose of 
furnishing care or services under this section. 
‘‘(h) USE OF CARD.—The Secretary shall ensure that 
the veteran health identification card, or such successor 
identification card, includes sufficient information to act 
as an identification card for an eligible entity or other non- 
Department facility. The Secretary may not use any 
amounts made available to the Secretary to issue separate 
identification cards solely for the purpose of carrying out 
this section. 
‘‘(i) PRESCRIPTION MEDICATIONS.—(1) With respect 
to requirements relating to the licensing or credentialing 
of a network provider, the Secretary shall ensure that the 
network provider is able to submit prescriptions for phar-
maceutical agents on the formulary of the Department to 
pharmacies of the Department in a manner that is sub-
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stantially similar to the manner in which the network pro-
vider submits prescriptions to retail pharmacies. 
‘‘(2) Nothing in this section shall be construed to af-
fect the process of the Department for filling and paying 
for prescription medications. 
‘‘(j) QUALITY OF CARE.—In carrying out this sec-
tion, the Secretary shall use the quality of care standards 
set forth or used by the Centers for Medicare & Medicaid 
Services or other quality of care standards, as determined 
by the Secretary. 
‘‘(k) CAPACITY AND COMMERCIAL MARKET ASSESS-
MENTS.—(1) On a periodic basis, but not less often than 
once every three years, the Secretary shall conduct an as-
sessment of the capacity of each Veterans Integrated Serv-
ice Network and medical facility of the Department to fur-
nish care or services under this chapter. Each such assess-
ment shall— 
‘‘(A) identify gaps in furnishing such care or 
services at such Veterans Integrated Service Net-
work or medical facility; 
‘‘(B) identify how such gaps can be filled by— 
‘‘(i) entering into contracts or agreements 
with network providers under this section or 
with entities under other provisions of law; 
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‘‘(ii) making changes in the way such care 
and services are furnished at such Veterans In-
tegrated Service Network or medical facility, in-
cluding but not limited to— 
‘‘(I) extending hours of operation; 
‘‘(II) adding personnel; or 
‘‘(III) expanding space through con-
struction, leasing, or sharing of health care 
facilities; and 
‘‘(iii) the building or realignment of De-
partment resources or personnel; 
‘‘(C) forecast, based on future projections and 
historical trends, both the short- and long-term de-
mand in furnishing care or services at such Veterans 
Integrated Service Network or medical facility and 
assess how such demand affects the needs to use 
such network providers; 
‘‘(D) include a commercial health care market 
assessment of designated catchment areas in the 
United States conducted by a nongovernmental enti-
ty; and 
‘‘(E) consider the unique ability of the Federal 
Government to retain a presence in an area other-
wise devoid of commercial health care providers or 
from which such providers are at a risk of leaving. 
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‘‘(2) The Secretary shall submit each assessment 
under paragraph (1) to the Committees on Veterans’ Af-
fairs of the House of Representatives and the Senate and 
shall make each such assessment publicly available. 
‘‘(l) ALLOCATION OF FUNDS.—The Secretary shall 
develop a plan for the allocation of funds in the Medical 
Community Care account. 
‘‘(m) REPORTS ON RATES.—Not later than Decem-
ber 31, 2019, and annually thereafter during each of the 
subsequent three years, the Secretary shall submit to the 
Committees on Veterans’ Affairs of the House of Rep-
resentatives and the Senate a report detailing, for the fis-
cal year preceding the fiscal year during which the report 
is submitted, the rates paid by the Secretary for hospital 
care, medical services, or extended care services under this 
section that, pursuant to subsection (d)(3), are more than 
the rates described in subsection (d)(2)(B) for the same 
care or services. 
‘‘(n) DEFINITIONS.—In this section: 
‘‘(1) The term ‘clean claim’ means a claim sub-
mitted— 
‘‘(A) to the covered payer by a covered 
claimant for purposes of payment by the cov-
ered payer of expenses for hospital care or med-
ical services furnished under this section; 
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‘‘(B) that contains substantially all of the 
required elements necessary for accurate adju-
dication, without requiring additional informa-
tion from the network provider; and 
‘‘(C) in such a nationally recognized for-
mat as may be prescribed by the Secretary for 
purposes of paying claims for hospital care or 
medical services furnished under this section. 
‘‘(2) The term ‘covered claimant’ means— 
‘‘(A) a network provider that submits a 
claim to the Secretary for purposes of payment 
by the Secretary of expenses for hospital care 
or medical services furnished under this section; 
or 
‘‘(B) a regional network operated by a con-
tractor pursuant to subsection (a)(4)(B) that 
submits a claim to the Secretary for purposes 
of reimbursement for a payment made by the 
contractor to a network provider for hospital 
care or medical services furnished under this 
section. 
‘‘(3) The term ‘covered payer’ means— 
‘‘(A) a regional network operated by a con-
tractor pursuant to subsection (a)(4)(B) with 
respect to a claim made by a network provider 
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‘‘(ii) requested a first-time appoint-
ment for hospital care or medical services 
at a Department facility. 
‘‘(5) The term ‘fraudulent claim’ means a claim 
by a network provider for reimbursement under this 
section that includes an intentional and deliberate 
misrepresentation of a material fact or facts that is 
intended to induce the Secretary to pay an amount 
that was not legally owed to the provider.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 17 of such title is 
amended by inserting after the item relating to sec-
tion 1703 the following new item: 
‘‘1703A. VA Care in the Community Program.’’. 
(b) CONFORMING AMENDMENTS.—The Veterans Ac-
cess, Choice, and Accountability Act of 2014 (Public Law 
113–146) is amended— 
(1) in section 101(p)(1) (38 U.S.C. 1701 note), 
by inserting before the period at the end the fol-
lowing: ‘‘or the date on which the Secretary certifies 
to the Committees on Veterans’ Affairs of the House 
of Representatives and the Senate that the Secretary 
is fully implementing section 1703A of title 38, 
United States Code, whichever occurs first’’; and 
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(2) in section 208(1), by striking ‘‘section 101’’ 
and inserting ‘‘section 1703A of title 38, United 
States Code’’. 
(c) DEFINITIONS.—Section 1701 of title 38, United 
States Code, is amended by adding at the end the fol-
lowing new paragraphs: 
‘‘(11) The term ‘network provider’ means any 
of the following health care providers that have en-
tered into a contract or agreement under which the 
provider agrees to furnish care and services to eligi-
ble veterans under section 1703A of this title: 
‘‘(A) Any health care provider or supplier 
that is participating in the Medicare Program 
under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.), including any physician 
furnishing services under such program. 
‘‘(B) Any provider of items and services re-
ceiving payment under a State plan under title 
XIX of such Act (42 U.S.C. 1396 et seq.) or 
a waiver of such a plan. 
‘‘(C) Any Federally-qualified health center 
(as defined in section 1905(l)(2)(B) of the So-
cial Security Act (42 U.S.C. 1396d(l)(2)(B))). 
‘‘(D) The Department of Defense. 
‘‘(E) The Indian Health Service. 
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‘‘(F) Any health care provider that is an 
academic affiliate of the Department. 
‘‘(G) Any health care provider not other-
wise covered under any of subparagraphs (A) 
through (F) that meets criteria established by 
the Secretary for purposes of such section. 
‘‘(12) The term ‘VA Care in the Community 
Program’ means the program under which the Sec-
retary furnishes hospital care or medical services to 
veterans through network providers pursuant to sec-
tion 1703A of this title.’’. 
(d) TRANSITION OF PROVISION OF CARE.—This Act, 
and the amendments made by this Act, may not be con-
strued to affect the obligations of the Secretary of Vet-
erans Affairs under contracts and agreements for the pro-
vision of hospital care, medical services, and extended care 
services entered into before the date of the enactment of 
this Act at the terms and rates contained in such contracts 
and agreements. 
SEC. 103. VETERANS CARE AGREEMENTS. 
(a) IN GENERAL.—Subchapter I of chapter 17 of title 
38, United States Code, is further amended by inserting 
after section 1703A, as added by section 102, the fol-
lowing new section: 
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‘‘§ 1703B. Veterans Care Agreements with non-net-
work providers 
‘‘(a) VETERANS CARE AGREEMENTS.—(1) In addi-
tion to furnishing hospital care, medical services, or ex-
tended care services under this chapter at facilities of the 
Department or under contracts or agreements entered into 
pursuant to section 1703A of this title or any other provi-
sion of law other than this section, the Secretary may fur-
nish such care and services to eligible veterans through 
the use of agreements, to be known as ‘Veterans Care 
Agreements’, entered into under this section by the Sec-
retary with eligible non-network providers. 
‘‘(2) The Secretary may enter into a Veterans Care 
Agreement under this section with an eligible non-network 
provider if the Secretary determines that— 
‘‘(A) the provision of the hospital care, medical 
services, or extended care services at a Department 
facility is impracticable or inadvisable because of the 
medical condition of the veteran, the travel involved, 
or the nature of the care or services required, or a 
combination of such factors; and 
‘‘(B) such care or services are not available to 
be furnished by a non-Department health care pro-
vider under a contract or agreement entered into 
pursuant to a provision of law other than this sec-
tion. 
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‘‘(3)(A) In accordance with subparagraphs (C) and 
(D), the Secretary shall review each Veterans Care Agree-
ment with a non-network provider to determine whether 
it is practical or advisable to, instead of carrying out such 
agreement— 
‘‘(i) provide at a Department facility the hos-
pital care, medical services, or extended care services 
covered by such agreement; or 
‘‘(ii) enter into an agreement with the provider 
under section 1703A of this title to provide such 
care or services. 
‘‘(B) If the Secretary determines pursuant to a re-
view of a Veterans Care Agreement under subparagraph 
(A) that it is practical or advisable to provide hospital 
care, medical services, or extended care services at a De-
partment facility, or enter into an agreement under sec-
tion 1703A of this title to provide such care or services, 
as the case may be, the Secretary— 
‘‘(i) may not renew the Veterans Care Agree-
ment; and 
‘‘(ii) shall take such actions as are necessary to 
implement such determination. 
‘‘(C) This paragraph shall apply with respect to Vet-
erans Care Agreements entered into with a non-network 
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provider whose gross annual revenue, as determined under 
subsection (b)(1), exceeds— 
‘‘(i) $3,000,000, in the case of a provider that 
furnishes homemaker or home health aide services; 
or 
‘‘(ii) $1,000,000, in the case of any other pro-
vider. 
‘‘(D) The Secretary shall conduct each review of a 
Veterans Care Agreement under subparagraph (A) as fol-
lows: 
‘‘(i) Once during the 18-month period beginning 
on the date that is six months after date on which 
the agreement is entered into. 
‘‘(ii) Not less than once during each four-year 
period beginning on the date on which the review 
under subparagraph (A) is conducted. 
‘‘(b) ELIGIBLE NON-NETWORK PROVIDERS.—A pro-
vider of hospital care, medical services, or extended care 
services is eligible to enter into a Veterans Care Agree-
ment under this section if the Secretary determines that 
the provider meets the following criteria: 
‘‘(1) The gross annual revenue of the provider 
under contracts or agreements entered into with the 
Secretary in the year preceding the year in which 
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XIX of such Act (42 U.S.C. 1396 et seq.) or 
a waiver of such a plan; 
‘‘(D) an Aging and Disability Resource 
Center, an area agency on aging, or a State 
agency (as defined in section 102 of the Older 
Americans Act of 1965 (42 U.S.C. 3002)); or 
‘‘(E) a center for independent living (as 
defined in section 702 of the Rehabilitation Act 
of 1973 (29 U.S.C. 796a)). 
‘‘(4) The provider is certified pursuant to the 
process established under subsection (c)(1). 
‘‘(5) Any additional criteria determined appro-
priate by the Secretary. 
‘‘(c) PROVIDER CERTIFICATION.—(1) The Secretary 
shall establish a process for the certification of eligible 
providers to enter into Veterans Care Agreements under 
this section that shall, at a minimum, set forth the fol-
lowing: 
‘‘(A) Procedures for the submission of applica-
tions for certification and deadlines for actions taken 
by the Secretary with respect to such applications. 
‘‘(B) Standards and procedures for the ap-
proval and denial of certifications and the revocation 
of certifications. 
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‘‘(C) Procedures for assessing eligible providers 
based on the risk of fraud, waste, and abuse of such 
providers similar to the level of screening under sec-
tion 1866(j)(2)(B) of the Social Security Act (42 
U.S.C. 1395(j)(2)(B)) and the standards set forth 
under section 9.104 of title 48, Code of Federal 
Regulations, or any successor regulation. 
‘‘(D) Requirement for denial or revocation of 
certification if the Secretary determines that the 
otherwise eligible provider is— 
‘‘(i) excluded from participation in a Fed-
eral health care program (as defined in section 
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); or 
‘‘(ii) identified as an excluded source on 
the list maintained in the System for Award 
Management, or any successor system. 
‘‘(E) Procedures by which a provider whose cer-
tification is denied or revoked under the procedures 
established under this subsection will be identified as 
an excluded source on the list maintained in the Sys-
tem for Award Management, or successor system, if 
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the Secretary determines that such exclusion is ap-
propriate. 
‘‘(2) To the extent practicable, the Secretary shall es-
tablish the procedures under paragraph (1) in a manner 
that takes into account any certification process adminis-
tered by another department or agency of the Federal 
Government that an eligible provider has completed by 
reason of being a provider described in any of subpara-
graphs (A) through (E) of subsection (b)(4). 
‘‘(d) TERMS OF AGREEMENTS.—Subsections (d), (e), 
(f), and (g) of section 1703A of this title shall apply with 
respect to a Veterans Care Agreement in the same manner 
such subsections apply to contracts and agreements en-
tered into under such section. 
‘‘(e) EXCLUSION
OF
CERTAIN
FEDERAL
CON-
TRACTING PROVISIONS.—(1) Notwithstanding any other 
provision of law, the Secretary may enter into a Veterans 
Care Agreement using procedures other than competitive 
procedures. 
‘‘(2)(A) Except as provided in subparagraph (B) and 
unless otherwise provided in this section, an eligible non- 
network provider that enters into a Veterans Care Agree-
ment under this section is not subject to, in the carrying 
out of the agreement, any provision of law that providers 
of services and suppliers under the original Medicare fee- 
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for-service program under parts A and B of title XVIII 
of the Social Security Act (42 U.S.C. 1395 et seq.) or the 
Medicaid program under title XIX of such Act (42 U.S.C. 
1396 et seq.) are not subject to. 
‘‘(B) In addition to the provisions of laws covered by 
subparagraph (A), an eligible non-network provider shall 
be subject to the following provisions of law: 
‘‘(i) Any applicable law regarding integrity, eth-
ics, or fraud, or that subject a person to civil or 
criminal penalties. 
‘‘(ii) Section 1352 of title 31, except for the fil-
ing requirements under subsection (b) of such sec-
tion. 
‘‘(iii) Section 4705 or 4712 of title 41, and any 
other applicable law regarding the protection of 
whistleblowers. 
‘‘(iv) Section 4706(d) of title 41. 
‘‘(v) Title VII of the Civil Rights Act of 1964 
(42 U.S.C. 2000e et seq.) to the same extent as 
such title applies with respect to the eligible non-net-
work provider in providing care or services through 
an agreement or arrangement other than under a 
Veterans Care Agreement. 
‘‘(f) TERMINATION OF A VETERANS CARE AGREE-
MENT.—(1) An eligible non-network provider may termi-
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nate a Veterans Care Agreement with the Secretary under 
this section at such time and upon such notice to the Sec-
retary as the Secretary may specify for purposes of this 
section. 
‘‘(2) The Secretary may terminate a Veterans Care 
Agreement with an eligible non-network provider under 
this section at such time and upon such notice to the pro-
vider as the Secretary may specify for the purposes of this 
section, if the Secretary determines necessary. 
‘‘(g) DISPUTES.—(1) The Secretary shall establish 
administrative procedures for providers with which the 
Secretary has entered into a Veterans Care Agreement to 
present any dispute arising under or related to the agree-
ment. 
‘‘(2) Before using any dispute resolution mechanism 
under chapter 71 of title 41 with respect to a dispute aris-
ing under a Veterans Care Agreement under this section, 
a provider must first exhaust the administrative proce-
dures established by the Secretary under paragraph (1). 
‘‘(h) AUTHORITY TO PAY FOR OTHER AUTHORIZED 
SERVICES.—(1) If, in the course of an episode of care for 
which hospital care, medical services, or extended care 
services are furnished to an eligible veteran pursuant to 
a Veterans Care Agreement, any part of such care or serv-
ices is furnished by a medical provider who is not an eligi-
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ble non-network provider or a network provider, the Sec-
retary may compensate such provider for furnishing such 
care or services. 
‘‘(2) The Secretary shall make reasonable efforts to 
enter into a Veterans Care Agreement with any provider 
who is compensated pursuant to paragraph (1). 
‘‘(i) ANNUAL REPORTS.—(1) Not later than Decem-
ber 31 of the year following the fiscal year in which the 
Secretary first enters into a Veterans Care Agreement 
under this section, and each year thereafter, the Secretary 
shall submit to the appropriate congressional committees 
an annual report that includes a list of all Veterans Care 
Agreements entered into as of the date of the report. 
‘‘(2) The requirement to submit a report under para-
graph (1) shall terminate on the date that is five years 
after the date of the enactment of this section. 
‘‘(j) QUALITY OF CARE.—In carrying out this sec-
tion, the Secretary shall use the quality of care standards 
set forth or used by the Centers for Medicare & Medicaid 
Services or other quality of care standards, as determined 
by the Secretary. 
‘‘(k) DELEGATION.—The Secretary may delegate the 
authority to enter into or terminate a Veterans Care 
Agreement to an official of the Department at a level not 
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below the Director of a Veterans Integrated Service Net-
work or the Director of a Network Contracting Office. 
‘‘(l) DEFINITIONS.—In this section: 
‘‘(1) The term ‘appropriate congressional com-
mittees’ means— 
‘‘(A) the Committees on Veterans’ Affairs 
of the House of Representatives and the Sen-
ate; and 
‘‘(B) the Committees on Appropriations of 
the House of Representatives and the Senate. 
‘‘(2) The term ‘eligible veteran’ has the mean-
ing given such term in section 1703A(m) of this 
title.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 1703A, as added by sec-
tion 102, the following new item: 
‘‘1703B. Veterans Care Agreements with non-network providers.’’. 
SEC. 104. MODIFICATION OF AUTHORITY TO ENTER INTO 
AGREEMENTS WITH STATE HOMES TO PRO-
VIDE NURSING HOME CARE. 
(a) USE OF AGREEMENTS.— 
(1) IN
GENERAL.—Paragraph (1) of section 
1745(a) of title 38, United States Code, is amended, 
in the matter preceding subparagraph (A), by strik-
ing ‘‘a contract (or agreement under section 
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1720(c)(1) of this title)’’ and inserting ‘‘an agree-
ment’’. 
(2) PAYMENT.—Paragraph (2) of such section 
is amended by striking ‘‘contract (or agreement)’’ 
each place it appears and inserting ‘‘agreement’’. 
(b) TREATMENT OF CERTAIN LAWS.—Such section 
is amended by adding at the end the following new para-
graph: 
‘‘(4)(A) An agreement under this section may be en-
tered into without regard to any law that would require 
the Secretary to use competitive procedures in selecting 
the party with which to enter into the agreement. 
‘‘(B)(i) Except as provided in clause (ii) and unless 
otherwise provided in this section or in regulations pre-
scribed 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 law to which pro-
viders of services and suppliers are not subject under the 
original Medicare fee-for-service program under parts A 
and B of title XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) or the Medicaid program under title XIX 
of such Act (42 U.S.C. 1396 et seq.). 
‘‘(ii) The exclusion under clause (i) does not apply 
to laws regarding integrity, ethics, fraud, or that subject 
a person to civil or criminal penalties. 
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‘‘(C) Title VII of the Civil Rights Act of 1964 (42 
U.S.C. 2000e et seq.) shall apply with respect to a State 
home that enters into an agreement under this section to 
the same extent as such title applies with respect to the 
State home in providing care or services through an agree-
ment or arrangement other than under this section.’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—The amendments made by 
this section shall apply to agreements entered into 
under section 1745 of such title on and after the 
date on which the regulations prescribed by the Sec-
retary of Veterans Affairs to implement such amend-
ments take effect. 
(2) PUBLICATION.—The Secretary shall publish 
the date described in paragraph (1) in the Federal 
Register not later than 30 days before such date. 
SEC. 105. DEPARTMENT OF VETERANS AFFAIRS ELEC-
TRONIC INTERFACE FOR PROCESSING OF 
MEDICAL CLAIMS. 
(a) ELECTRONIC INTERFACE.—Not later than the 
implementation date specified in section 108(a), the Chief 
Information Officer of the Department of Veterans Affairs 
shall ensure that the information technology system used 
by the Department to receive, process, and pay claims 
under the VA Care in the Community Program estab-
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lished in section 1703A of title 38, United States Code, 
as added by section 102, and under Veterans Care Agree-
ments established in section 1703B of such title, as added 
by section 103, includes the following: 
(1) A function through which a covered non-De-
partment health care provider may submit all re-
quired data and supporting information required for 
claims reimbursement through electronic data inter-
changes. 
(2) An ability to automatically adjudicate 
claims. 
(3) A centralized claims database that is acces-
sible nationwide. 
(4) Integration with the relevant eligibility and 
authorization information technology systems of the 
Department. 
(5) Ability for a covered non-Department health 
care provider to ascertain the status of a pending 
claim submitted by the provider, receive information 
regarding missing documentation or discrepancies 
that may impede claim processing timelines or result 
in rejection, and receive notification when such claim 
is accepted for reimbursement or rejected. 
(6) A claim review system similar to that used 
by the Centers for Medicare & Medicaid Services, as 
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of the date of the enactment of this Act, to deter-
mine the appropriateness and accuracy of payments 
to providers and to ensure program integrity and 
oversight. 
(b) SECURITY AND PRIVACY.—The Chief Information 
Officer shall also ensure that the information technology 
system covered under subsection (a) meets the following 
criteria: 
(1) Such system shall be developed and imple-
mented in compliance with all applicable laws, regu-
lations and Federal Government standards regarding 
information security, privacy, and accessibility. 
(2) Such system shall provide for the elicitation, 
analysis, and prioritization of functional and non-
functional information security and privacy require-
ments for such system, including security and pri-
vacy services and architectural requirements relating 
to security and privacy based on a thorough risk as-
sessment of all reasonably anticipated cyber and 
noncyber threats to the security and privacy of elec-
tronic protected health information made available 
through such interface. 
(3) Such system shall provide for the elicitation, 
analysis, and prioritization of secure development re-
quirements relating to such system. 
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(4) Such system shall provide assurance that 
the prioritized information security and privacy re-
quirements of such system— 
(A) are correctly implemented in the de-
sign and implementation of such system 
through the systems development lifecycle; and 
(B) satisfy the information objectives of 
such system relating to security and privacy 
throughout the systems development lifecycle. 
(c) CONTRACT AUTHORITY.—The Chief Information 
Officer may enter into a contract for purposes of carrying 
out this section. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘electronic protected health infor-
mation’’ 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. 
(2) The term ‘‘covered non-Department health 
care provider’’ means— 
(A) a network provider (as defined by sec-
tion 1701(11) of title 38, United States Code, 
as added by section 102); 
(B) a non-network provider with which the 
Secretary has entered into a Veterans Care 
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Agreement under section 1703B of such title, 
as added by section 103; or 
(C) any other non-Department eligible pro-
vider or non-Department health care provider 
that furnishes hospital care or medical services 
pursuant to chapter 17 of such title. 
(3) The term ‘‘secure development require-
ments’’ means, with respect to the information tech-
nology system established under subsection (a), ac-
tivities that are required to be completed during the 
system development lifecycle of such interface, such 
as secure coding principles and test methodologies. 
(4) The term ‘‘VA Care in the Community Pro-
gram’’ has the meaning given that term in section 
1701(12) of title 38, United States Code, as added 
by section 102. 
SEC. 106. FUNDING FOR VA CARE IN THE COMMUNITY PRO-
GRAM. 
(a) IN GENERAL.—All amounts required to carry out 
the VA Care in the Community Program and Veterans 
Care Agreements under section 1703B of title 38, United 
States Code, shall be derived from the Veterans Health 
Administration, Medical Community Care account. 
(b) TRANSFER OF AMOUNTS.— 
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(1) IN GENERAL.—Any unobligated amounts in 
the Veterans Choice Fund under section 802 of the 
Veterans Access, Choice, and Accountability Act of 
2014 (Public Law 113–146; 38 U.S.C. 1701 note) 
shall be transferred to the Veterans Health Adminis-
tration, Medical Community Care account on the 
later of the following dates: 
(A) The date that is one year after the 
date of the enactment of this Act. 
(B) The date on which the Secretary of 
Veterans Affairs submits to the Committees on 
Veterans’ Affairs of the Senate and the House 
of Representatives the certification required by 
section 107(c). 
(2) CONFORMING REPEAL.— 
(A) IN
GENERAL.—Effective immediately 
following the transfer of amounts under para-
graph (1), section 802 of the Veterans Access, 
Choice, and Accountability Act of 2014 (Public 
Law 113–146; 38 U.S.C. 1701 note) is re-
pealed. 
(B) CONFORMING
AMENDMENT.—Section 
4003 of the Surface Transportation and Vet-
erans Health Care Choice Improvement Act of 
2015 (Public Law 114–41; 38 U.S.C. 1701 
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note) is amended by striking ‘‘for non-Depart-
ment provider programs (as defined in section 
2(d))’’ and all that follows through ‘‘1802)’’ 
and inserting the following: ‘‘for the VA Care in 
the Community Program (as defined in section 
1701(12) of title 38, United States Code) and 
Veterans 
Care 
Agreements 
under 
section 
1703B of title 38, United States Code’’. 
(c) VA CARE IN THE COMMUNITY PROGRAM DE-
FINED.—In this section, the term ‘‘VA Care in the Com-
munity Program’’ has the meaning given that term in sec-
tion 1701(12) of title 38, United States Code, as added 
by section 102. 
SEC. 107. TERMINATION OF CERTAIN PROVISIONS AUTHOR-
IZING 
MEDICAL 
CARE 
TO 
VETERANS 
THROUGH NON-DEPARTMENT OF VETERANS 
AFFAIRS PROVIDERS. 
(a) TERMINATION OF AUTHORITY TO CONTRACT FOR 
CARE IN NON-DEPARTMENT FACILITIES.— 
(1) IN
GENERAL.—Section 1703 of title 38, 
United States Code, is amended by adding at the 
end the following new subsection: 
‘‘(e) The authority of the Secretary to carry out this 
section terminates on the date on which the Secretary cer-
tifies to the Committees on Veterans’ Affairs of the House 
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of Representatives and the Senate that the Secretary is 
fully implementing section 1703A of this title.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) DENTAL
CARE.—Section 1712(a) of 
such title is amended— 
(i) in paragraph (3), by striking 
‘‘under clause (1), (2), or (5) of section 
1703(a) of this title’’ and inserting ‘‘under 
the VA Care in the Community Program’’; 
and 
(ii) in paragraph (4)(A), in the first 
sentence— 
(I) by striking ‘‘and section 1703 
of this title’’ and inserting ‘‘and the 
VA Care in the Community Program 
(with respect to such a year beginning 
on or after the date on which the Sec-
retary commences implementation of 
the VA Care in the Community Pro-
gram)’’; and 
(II) by striking ‘‘in section 1703 
of this title’’ and inserting ‘‘under the 
VA Care in the Community Pro-
gram’’. 
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(2) CLERICAL AMENDMENT.—The table of sec-
tions at the beginning of chapter 74 of such title is 
amended by striking the item relating to section 
7409. 
(c) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall take effect on the date on 
which the Secretary certifies to the Committees on Vet-
erans’ Affairs of the House of Representatives and the 
Senate that the Secretary is fully implementing section 
1703A of title 38, United States Code, as added by section 
102. 
SEC. 108. IMPLEMENTATION AND TRANSITION. 
(a) IMPLEMENTATION.—The Secretary of Veterans 
Affairs shall commence the implementation of section 
1703A of title 38, United States Code, as added by section 
102, and section 1703B of such title, as added by section 
103, and shall make the transfer under section 106(b), 
by not later than one year after the date of the enactment 
of this Act. The Secretary shall prescribe interim final reg-
ulations to implement such sections and publish such reg-
ulations in the Federal Register. 
(b) TRAINING.—Before commencing the implementa-
tion of sections 1703A and 1703B of title 38, United 
States Code, as added by sections 102 and 103, respec-
tively, the Secretary of Veterans Affairs shall— 
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(1) certify to the Committees on Veterans’ Af-
fairs of the House of Representatives and the Senate 
that— 
(A) each network provider (as defined by 
section 1701(11) of title 38, United States 
Code) and eligible non-network provider that 
furnishes care or services under such section 
1703A or section 1703B is trained to furnish 
such care or services under such sections; and 
(B) each employee of the Department that 
refers, authorizes, or coordinates such care or 
services is trained to carry out such sections; 
and 
(2) establish standard, written guidance for net-
work providers, non-Department health care pro-
viders, and any non-Department administrative enti-
ties acting on behalf of such providers, with respect 
to the policies and procedures for furnishing care or 
services under such sections. 
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TITLE II—OTHER 
ADMINISTRATIVE MATTERS 
SEC. 201. REIMBURSEMENT FOR EMERGENCY AMBULANCE 
SERVICES. 
(a) IN GENERAL.—Section 1725(c) of title 38, 
United States Code, is amended by adding at the end the 
following new paragraph: 
‘‘(5) In delineating the circumstances under which re-
imbursement may be made under this section for ambu-
lance services for an individual, the Secretary shall treat 
such services as emergency services for which reimburse-
ment may be made under this section if the Secretary de-
termines that— 
‘‘(A) the request for ambulance services was 
made as a result of the sudden onset of a medical 
condition of such a nature that a prudent layperson 
who possesses an average knowledge of health and 
medicine— 
‘‘(i) would have reasonably expected that a 
delay in seeking immediate medical attention 
would have been hazardous to the life or health 
of the individual; or 
‘‘(ii) could reasonably expect the absence 
of immediate medical attention to result in 
placing the health of the individual in serious 
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jeopardy, the serious impairment of bodily func-
tions, or the serious dysfunction of any bodily 
organ or part; and 
‘‘(B) the individual is transported to the most 
appropriate medical facility capable of treating such 
medical condition.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act and shall apply with respect to ambulance 
services provided on or after January 1, 2019. 
SEC. 202. IMPROVEMENT OF CARE COORDINATION FOR 
VETERANS THROUGH EXCHANGE OF CER-
TAIN MEDICAL RECORDS. 
Section 7332(b) of title 38, United States Code, is 
amended— 
(1) in paragraph (2), by adding at the end the 
following new subparagraphs: 
‘‘(H) To a public or private health care 
provider in order to provide treatment or health 
care to a shared patient. 
‘‘(I) To a third party in order to recover 
or collect reasonable charges for care furnished 
to a veteran for a non-service-connected dis-
ability pursuant to section 1729 of this title or 
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section 1 of Public Law 87–693 (42 U.S.C. 
2651).’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) Nothing in this section shall be construed to au-
thorize any provision of records in violation of relevant 
health record privacy laws, including the Health Insurance 
Portability and Accountability Act of 1996 (Public Law 
104–191).’’. 
SEC. 203. ELIMINATION OF COPAYMENT OFFSET. 
(a) IN GENERAL.—Section 1729(a) of title 38, 
United States Code, is amended by adding at the end the 
following new paragraph: 
‘‘(4) Notwithstanding any other provision of 
law, any amount that the United States may collect 
or recover under this section shall not affect any co-
payment amount a veteran is otherwise obligated to 
pay under this chapter.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect on the date of the enact-
ment of this Act and apply with respect to a copayment 
obligation that arises on or after the date of the enactment 
of this Act. 
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SEC. 204. USE OF DEPARTMENT OF VETERANS AFFAIRS 
MEDICAL CARE COLLECTIONS FUND FOR 
CERTAIN IMPROVEMENTS IN COLLECTIONS. 
Section 1729A(c)(1)(B) of title 38, United States 
Code, is amended by inserting ‘‘(including with respect to 
automatic data processing or information technology im-
provements)’’ after ‘‘collection’’. 
SEC. 205. DEPARTMENT OF VETERANS AFFAIRS HEALTH 
CARE PRODUCTIVITY IMPROVEMENT. 
(a) IN GENERAL.—Subchapter I of chapter 17 of title 
38, United States Code, is further amended by inserting 
after section 1705A the following new section: 
‘‘§ 1705B. Management of health care: productivity 
‘‘(a) RELATIVE VALUE UNIT TRACKING.—The Sec-
retary shall track relative value units for all Department 
providers. 
‘‘(b) CLINICAL PROCEDURE CODING TRAINING.— 
The Secretary shall require all Department providers to 
attend training on clinical procedure coding. 
‘‘(c) PERFORMANCE STANDARDS.—The Secretary 
shall establish for each Department facility— 
‘‘(1) standardized performance standards based 
on nationally recognized relative value unit produc-
tion standards applicable to each specific profession 
in order to evaluate clinical productivity at the pro-
vider and facility level; 
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‘‘(2) remediation plans to address low clinical 
productivity and clinical inefficiency; and 
‘‘(3) an ongoing process to systematically re-
view the content, implementation, and outcome of 
the plans developed under paragraph (2). 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) The term ‘Department provider’ means an 
employee of the Department whose primary respon-
sibilities include furnishing hospital care or medical 
services, including a physician, a dentist, an optom-
etrist, a podiatrist, a chiropractor, an advanced 
practice registered nurse, and a physician’s assistant 
acting as an independent provider. 
‘‘(2) The term ‘relative value unit’ means a unit 
for measuring workload by determining the time, 
mental effort and judgment, technical skill, physical 
effort, and stress involved in delivering a proce-
dure.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is further amended by 
inserting after the item relating to section 1705A the fol-
lowing new item: 
‘‘1705B. Management of health care: productivity.’’. 
(c) REPORT.—Not later than one year after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on the implementation of section 
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1705B of title 38, United States Code, as added by sub-
section (a). Such report shall include, for each professional 
category of Department providers, the relative value unit 
of such category of providers at the national, Veterans In-
tegrated Service Network, and facility levels. 
SEC. 206. LICENSURE OF HEALTH CARE PROFESSIONALS 
OF THE DEPARTMENT OF VETERANS AF-
FAIRS PROVIDING TREATMENT VIA TELE-
MEDICINE. 
(a) IN GENERAL.—Chapter 17 of title 38, United 
States Code, is further amended by inserting after section 
1730A the following new section: 
‘‘§ 1730B. Licensure of health care professionals pro-
viding treatment via telemedicine 
‘‘(a) IN GENERAL.—Notwithstanding any provision 
of law regarding the licensure of health care professionals, 
a covered health care professional may practice the health 
care profession of the health care professional at any loca-
tion in any State, regardless of where the covered health 
care professional or the patient is located, if the covered 
health care professional is using telemedicine to provide 
treatment to an individual under this chapter. 
‘‘(b) PROPERTY OF FEDERAL GOVERNMENT.—Sub-
section (a) shall apply to a covered health care professional 
providing treatment to a patient regardless of whether the 
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covered health care professional or patient is located in 
a facility owned by the Federal Government during such 
treatment. 
‘‘(c) CONSTRUCTION.—Nothing in this section may 
be construed to remove, limit, or otherwise affect any obli-
gation of a covered health care professional under the Con-
trolled Substances Act (21 U.S.C. 801 et seq.). 
‘‘(d) COVERED HEALTH CARE PROFESSIONAL DE-
FINED.—In this section, the term ‘covered health care pro-
fessional’ means a health care professional who— 
‘‘(1) is an employee of the Department ap-
pointed under the authority under section 7306, 
7401, 7405, 7406, or 7408 of this title, or title 5; 
‘‘(2) is authorized by the Secretary to provide 
health care under this chapter; 
‘‘(3) is required to adhere to all quality stand-
ards relating to the provision of telemedicine in ac-
cordance with applicable policies of the Department; 
and 
‘‘(4) has an active, current, full, and unre-
stricted license, registration, or certification in a 
State to practice the health care profession of the 
health care professional.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of chapter 17 of such title is further 
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amended by inserting after the item relating to section 
1730A the following new item: 
‘‘1730B. Licensure of health care professionals providing treatment via telemedi-
cine.’’. 
(c) REPORT ON TELEMEDICINE.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary of Veterans Affairs shall submit to the Com-
mittee on Veterans’ Affairs of the Senate and the 
Committee on Veterans’ Affairs of the House of 
Representatives a report on the effectiveness of the 
use of telemedicine by the Department of Veterans 
Affairs. 
(2) ELEMENTS.—The report required by para-
graph (1) shall include an assessment of the fol-
lowing: 
(A) The satisfaction of veterans with tele-
medicine furnished by the Department. 
(B) The satisfaction of health care pro-
viders in providing telemedicine furnished by 
the Department. 
(C) The effect of telemedicine furnished by 
the Department on the following: 
(i) The ability of veterans to access 
health care, whether from the Department 
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or from non-Department health care pro-
viders. 
(ii) The frequency of use by veterans 
of telemedicine. 
(iii) The productivity of health care 
providers. 
(iv) Wait times for an appointment 
for the receipt of health care from the De-
partment. 
(v) The reduction, if any, in the use 
by veterans of in-person services at De-
partment facilities and non-Department fa-
cilities. 
(D) The types of appointments for the re-
ceipt of telemedicine furnished by the Depart-
ment that were provided during the one-year 
period preceding the submittal of the report. 
(E) The number of appointments for the 
receipt of telemedicine furnished by the Depart-
ment that were requested during such period, 
disaggregated by Veterans Integrated Service 
Network. 
(F) Savings by the Department, if any, in-
cluding travel costs, of furnishing health care 
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through the use of telemedicine during such pe-
riod. 
Æ 
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