I 
115TH CONGRESS 
2D SESSION 
H. R. 4783 
To amend the Veterans Access, Choice, and Accountability Act of 2014 
to improve the scheduling of appointments, the accountability of third 
party administrators, and payment to providers under such Act, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 11, 2018 
Ms. ROSEN (for herself and Mr. JONES) introduced the following bill; which 
was referred to the Committee on Veterans’ Affairs 
A BILL 
To amend the Veterans Access, Choice, and Accountability 
Act of 2014 to improve the scheduling of appointments, 
the accountability of third party administrators, and pay-
ment to providers under such Act, and for other pur-
poses. 
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 ‘‘Veterans Deserve Bet-
ter Act’’. 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
SEC. 2. PAYMENT TO PROVIDERS UNDER VETERANS 
CHOICE 
PROGRAM, 
SCHEDULING 
OF 
AP-
POINTMENTS, 
AND 
ACCOUNTABILITY 
OF 
THIRD 
PARTY 
ADMINISTRATORS 
UNDER 
SUCH PROGRAM. 
Section 101 of the Veterans Access, Choice, and Ac-
countability Act of 2014 (Public Law 113–146; 38 U.S.C. 
1701 note) is amended by adding at the end the following 
new subsections: 
‘‘(u) PROMPT PAYMENT.— 
‘‘(1) PAYMENT OF CLAIMS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this section or any other pro-
vision of law, the Secretary shall pay for hos-
pital care or medical services furnished by a 
health care entity or provider under this section 
within 45 calendar days upon receipt of a clean 
paper claim or 30 calendar days upon receipt of 
a clean electronic claim. 
‘‘(B) DENIAL.—If a claim is denied, the 
Secretary shall, within 45 calendar days of de-
nial for a paper claim and 30 calendar days of 
denial for an electronic claim, notify the health 
care entity or provider of the reason for denying 
the claim and what, if any, additional informa-
tion is required to process the claim. 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
‘‘(C) ADDITIONAL
INFORMATION.—Upon 
the receipt of additional information described 
in subparagraph (B) with respect to a denied 
claim, the Secretary shall ensure that the claim 
is paid, denied, or otherwise adjudicated within 
30 calendar days from the receipt of the re-
quested information. 
‘‘(D) INVOICE
BASIS.—This subsection 
shall only apply to payments made on an in-
voice basis and shall not apply to capitation or 
other forms of periodic payment. 
‘‘(2) SUBMITTAL
OF
CLAIMS.—A health care 
entity or provider that furnishes hospital care or 
medical services under this section shall submit to 
the Secretary a claim for payment for furnishing the 
hospital care or medical services not later than 180 
days after the date on which the health care entity 
or provider furnished the hospital care or medical 
services. 
‘‘(3) FRAUDULENT CLAIMS.— 
‘‘(A) 
IN
GENERAL.—Sections 
3729 
through 3733 of title 31, United States Code, 
shall apply to fraudulent claims for payment 
submitted to the Secretary by a health care en-
tity or provider under this section. 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
‘‘(B) PRECLUSION
OF
CERTAIN
PRO-
VIDERS.—Pursuant to regulations prescribed by 
the Secretary, the Secretary shall bar a health 
care entity or provider from furnishing hospital 
care or medical services under this section if the 
Secretary determines the health care entity or 
provider has submitted to the Secretary fraudu-
lent health care claims for payment by the Sec-
retary. 
‘‘(4) OVERDUE CLAIMS.— 
‘‘(A) IN
GENERAL.—Any claim that has 
not been denied with notice, made pending with 
notice, or paid to a health care entity or pro-
vider by the Secretary shall be overdue if the 
notice or payment is not received by the health 
care entity or provider within the time periods 
specified in paragraph (1). 
‘‘(B) INTEREST.— 
‘‘(i) IN GENERAL.—If a claim is over-
due under this paragraph, the Secretary 
may, under the requirements established 
by paragraph (1) and consistent with the 
provisions of chapter 39 of title 31, United 
States Code (commonly referred to as the 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
‘Prompt Payment Act’), require that inter-
est be paid on clean claims. 
‘‘(ii) COMPUTATION.—Interest paid 
under clause (i) shall be computed at the 
rate of interest established by the Sec-
retary of the Treasury under section 3902 
of title 31, United States Code, and pub-
lished in the Federal Register. 
‘‘(C) REPORT.—Not less frequently than 
annually, the Secretary shall submit to Con-
gress a report on payment of overdue claims 
under this paragraph, disaggregated by paper 
and electronic claims, that includes the fol-
lowing: 
‘‘(i) The amount paid in overdue 
claims under this paragraph, disaggregated 
by the amount of the overdue claim and 
the amount of interest paid on such over-
due claim. 
‘‘(ii) The number of such overdue 
claims and the average number of days 
late each claim was paid, disaggregated by 
facility of the Department and Veterans 
Integrated Service Network region. 
‘‘(5) OVERPAYMENT.— 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the Secretary shall deduct 
the amount of any overpayment from payments 
due a health care entity or provider under this 
section. 
‘‘(B) NOTIFICATION
OF
RIGHT
TO
DIS-
PUTE.— 
‘‘(i) IN
GENERAL.—Deductions may 
not be made under this paragraph unless 
the Secretary has made reasonable efforts 
to notify a health care entity or provider of 
the right to dispute the existence or 
amount of such indebtedness and the right 
to request a compromise of such indebted-
ness. 
‘‘(ii) 
DETERMINATION.—The 
Sec-
retary shall make a determination with re-
spect to any dispute or request under 
clause (i) prior to deducting any overpay-
ment under this paragraph unless the time 
required to make such a determination be-
fore making any deductions would jeop-
ardize the Secretary’s ability to recover the 
full amount of such indebtedness. 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
‘‘(6) INFORMATION AND DOCUMENTATION RE-
QUIRED.— 
‘‘(A) IN
GENERAL.—The Secretary shall 
provide to all health care entities or providers 
furnishing hospital care or medical services 
under this section a list of information and doc-
umentation that is required to establish a clean 
claim under this subsection. 
‘‘(B) CONSULTATION WITH HEALTH CARE 
ENTITIES.—The Secretary shall consult with 
entities in the health care industry, in the pub-
lic and private sector, to determine the informa-
tion and documentation to include in the list 
under subparagraph (A). 
‘‘(C) NOTIFICATION OF MODIFICATIONS.— 
If the Secretary modifies the information and 
documentation included in the list under sub-
paragraph (A), the Secretary shall notify all 
health care entities or providers described in 
such subparagraph not later than 30 days be-
fore such modifications take effect. 
‘‘(7) PROCESSING OF CLAIMS.—In processing a 
claim for compensation for hospital care or medical 
services furnished by a health care entity or provider 
under this section, the Secretary shall act through— 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
‘‘(A) a non-Department entity that has en-
tered into an agreement with the Secretary 
under this section; or 
‘‘(B) a non-Department entity that special-
izes in processing such claims for other Federal 
agency health care systems. 
‘‘(8) TREATMENT
OF
CERTAIN
OUTSTANDING 
CLAIMS.— 
‘‘(A) REPORT.—Not later than 30 days 
after the date of the enactment of the Veterans 
Deserve Better Act, the Secretary shall submit 
to the appropriate committees of Congress a re-
port on the number of claims for payment for 
hospital care and medical services furnished to 
eligible veterans under this section that are out-
standing as of the date of the submittal of the 
report. 
‘‘(B) OUTREACH
TO
PROVIDERS.—Not-
withstanding any other provision of this section, 
with respect to each health care entity or pro-
vider that has an outstanding claim for pay-
ment for hospital care and medical services fur-
nished to eligible veterans under this section as 
of the date of the enactment of the Veterans 
Deserve Better Act, not later than 45 days 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
after such date of enactment, the Secretary 
shall either pay the claim, deny the claim, or re-
quest additional information regarding the 
claim. 
‘‘(9) DEFINITIONS.—In this subsection: 
‘‘(A) The term ‘appropriate committees of 
Congress’ means— 
‘‘(i) the Committee on Veterans’ Af-
fairs and the Committee on Appropriations 
of the Senate; and 
‘‘(ii) the Committee on Veterans’ Af-
fairs and the Committee on Appropriations 
of the House of Representatives. 
‘‘(B) The term ‘clean electronic claim’ 
means the transmission of data for purposes of 
payment of covered health care expenses that is 
submitted to the Secretary which contains sub-
stantially all of the required data elements nec-
essary for accurate adjudication, without ob-
taining additional information from the health 
care entity or provider that furnished the care 
or service, submitted in such format as pre-
scribed by the Secretary in regulations for the 
purpose of paying claims for care or services. 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
‘‘(w) REQUIREMENTS OF THIRD PARTY ADMINIS-
TRATORS.— 
‘‘(1) APPOINTMENT
TIMING.—The Secretary 
shall ensure that each contract with a third party 
administrator requires the third party administrator 
to schedule an appointment for care or services 
under this section for an eligible veteran not later 
than five days after the eligible veteran elects to re-
ceive such care or services under this section. 
‘‘(2) TRACKING OF APPOINTMENTS.—The Sec-
retary shall track all appointments for care and 
services under this section that are scheduled di-
rectly through a third party administrator. 
‘‘(3) FOLLOW-UP.—The Secretary shall follow 
up with a third party administrator regarding any 
appointment for care or services under this section 
that is pending to be scheduled by the third party 
administrator for more than 5 days to determine the 
reason for the delay in scheduling the appointment. 
‘‘(4) REPORT ON OVERDUE APPOINTMENTS.— 
The Secretary shall require each third party admin-
istrator to submit to the Secretary, not later than 30 
days after the date of the enactment of the Veterans 
Deserve Better Act, a list of the appointments that, 
as of the submittal of the report, have been pending 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS
scheduling by the third party administrator for a pe-
riod of more than 15 days.’’. 
Æ 
VerDate Sep 11 2014 
00:18 Jan 17, 2018
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6301
E:\BILLS\H4783.IH
H4783
lotter on DSKBCFDHB2PROD with BILLS