IB 
Union Calendar No. 444 
115TH CONGRESS 
2D SESSION 
H. R. 4242 
[Report No. 115–585] 
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 
MARCH 5, 2018 
Additional sponsors: Mr. EMMER, Mr. STEWART, Mr. MESSER, Mr. HUDSON, 
Mr. JOHNSON of Ohio, and Mr. WEBSTER of Florida 
MARCH 5, 2018 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on November 3, 2017] 
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A BILL 
To amend title 38, United States Code, to establish a perma-
nent VA Care in the Community Program, and for other 
purposes. 
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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’’. 
(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 veterans 
through non-Department of Veterans Affairs providers. 
Sec. 108. Implementation and transition. 
Sec. 109. Transplant procedures with live donors and related services. 
TITLE II—OTHER ADMINISTRATIVE MATTERS 
Sec. 201. Reimbursement for emergency ambulance services. 
Sec. 202. Improvement of care coordination for veterans through exchange of cer-
tain 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 improvement. 
Sec. 206. Licensure of health care professionals of the Department of Veterans Af-
fairs providing treatment via telemedicine. 
Sec. 207. Establishment of processes to ensure safe opioid prescribing practices by 
non-Department of Veterans Affairs health care providers. 
Sec. 208. Assessment of health care furnished by the Department to veterans who 
live in the territories. 
Sec. 209. Oversight and accountability of financial processes of Department of 
Veterans Affairs. 
Sec. 210. Authority for Department of Veterans Affairs Center for Innovation for 
Care and Payment. 
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TITLE III—IMPROVEMENTS TO RECRUITMENT OF PHYSICIANS 
Sec. 301. Designated scholarships for physicians and dentists under Department 
of Veterans Affairs Health Professional Scholarship Program. 
Sec. 302. Establishment of Department of Veterans Affairs Specialty Education 
Loan Repayment Program. 
Sec. 303. Veterans healing veterans medical access and scholarship program. 
TITLE I—IMPROVED ACCESS FOR 
VETERANS TO NON-DEPART-
MENT OF VETERANS AFFAIRS 
MEDICAL CARE 
SEC. 101. ASSIGNMENT OF VETERANS TO PRIMARY CARE 
PROVIDERS. 
Section 1706 of title 38, United States Code, is amend-
ed by adding at the end the following new subsection: 
‘‘(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— 
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‘‘(A) provide to each eligible veteran comprehen-
sive primary care in partnership with the veteran; 
and 
‘‘(B) manage and coordinate comprehensive hos-
pital 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 veteran 
is not simultaneously assigned to more than one patient- 
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. 
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 system 
of the Department established and operated under sec-
tion 1705(a) of this title; and 
‘‘(B) has— 
‘‘(i) been furnished hospital care or medical 
services at or through a Department facility on 
at least one occasion during the two-year period 
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preceding the date of the determination of eligi-
bility; 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 COMMUNITY 
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: 
‘‘§ 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 agree-
ments authorized under subsection (d), or contracts or 
agreements, including national contracts or agreements, au-
thorized under section 8153 of this title or any other provi-
sion of law administered by the Secretary, with network 
providers for the furnishing of such care and services to vet-
erans. 
‘‘(2) Subject to subsection (b), an eligible veteran may 
select a provider of such care or services from among net-
work providers. 
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‘‘(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 regions 
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. 
‘‘(C) The Secretary shall— 
‘‘(i) verify upon enrollment, and annually there-
after, that network providers have not been excluded 
from participation in other federally funded health 
care programs; and 
‘‘(ii) submit to the Committees on Veterans’ Af-
fairs of the House of Representatives and the Senate 
an annual report on the results of such verifications. 
‘‘(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 de-
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termines 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 ex-
cessive 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; 
‘‘(II) environmental factors, including roads 
that are not accessible to the general public, traf-
fic, or hazardous weather; 
‘‘(III) a medical condition of the veteran; or 
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‘‘(IV) such other factors as determined by 
the Secretary. 
‘‘(ii) Whether the veteran reasonably believes that 
the assignment of a particular care team or provider 
to the veteran would detrimentally affect the patient- 
provider relationship and result in sub-optimal care 
to the veteran. 
‘‘(iii) Whether the panel size of the care team or 
provider is at such a number that it would result in 
difficulty for the veteran in accessing timely care or 
in sub-optimal care to the veteran. 
‘‘(iv) Whether the veteran resides in a State 
where the Department does not operated a full-service 
medical facility. 
‘‘(C) If the Secretary determines that a patient-aligned 
care team or dedicated primary care provider at a Depart-
ment facility has become available for assignment to an eli-
gible veteran who had been assigned to a network provider 
under subparagraph (A), the Secretary shall provide the 
veteran with the option of reassignment to the team or pro-
vider at the Department facility. 
‘‘(D) In the case of an eligible veteran who is assigned 
to a network provider under subparagraph (A), the Sec-
retary shall reevaluate such assignment not earlier than one 
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year after a veteran makes a selection under subparagraph 
(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 furnish 
specialty hospital care, medical services, or extended care 
services to an eligible veteran pursuant to subparagraph 
(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; 
‘‘(ii) by a network provider that, to the greatest 
extent practicable, is located in the regional network 
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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 network 
provider under which— 
‘‘(i) specialty hospital care, medical services, or 
extended care services are furnished to an eligible vet-
eran pursuant to subparagraph (A)— 
‘‘(I) at a medical facility of the Department 
by a network provider possessing the appropriate 
credentials, as determined by the Secretary; 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 re-
spect to fees and payments for care and services 
furnished under subsection (a); or 
‘‘(II) at no cost to the United States. 
‘‘(D) In making the determination under subpara-
graph (B), the Secretary shall give priority to medical fa-
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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 re-
spect to— 
‘‘(I) geographical challenges; 
‘‘(II) environmental factors, such as roads 
that are not accessible to the general public, traf-
fic, or hazardous weather; 
‘‘(III) a medical condition of the veteran; or 
‘‘(IV) such other factors as determined by 
the Secretary; 
‘‘(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; 
‘‘(iii) whether the veteran resides in a State 
where the Department does not operate a full-service 
medical facility; and 
‘‘(iv) in the case of a veteran who requires an 
organ or bone marrow transplant, whether the veteran 
has, in the opinion of the primary care provider of 
the veteran, a medically compelling reason to travel 
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outside the region of the Organ Procurement and 
Transplantation Network, established under section 
372 of the National Organ Transplantation Act (Pub-
lic Law 98–507; 42 U.S.C. 274), in which the veteran 
resides, to receive such transplant. 
‘‘(E) The Secretary shall ensure that each medical fa-
cility of the Department processes referrals for specialty 
hospital care, medical services, or extended care services in 
a standardized manner, including with respect to the orga-
nization of the program office responsible for such referrals. 
‘‘(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 eligible 
veteran and a health care provider of the Department, re-
garding the eligibility of the veteran to receive care or serv-
ices from a network provider under this section or the as-
signment 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 pa-
tient aligned care team or dedicated primary care provider, 
the Secretary may give deference to the veteran with respect 
to any determination under subsection (b)(1)(B)(ii). 
‘‘(G)(i) The Secretary shall develop procedures to en-
sure that assigning a veteran to a patient-aligned care team 
or dedicated primary care provider under subparagraph 
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(A), (C), or (D) does not adversely affect the continuity or 
quality of care for the veteran during the transition. 
‘‘(ii) Procedures under clause (i) shall provide for— 
‘‘(I) the appointment of a contact in the Depart-
ment for the veteran who shall provide information to 
the veteran and resolve issues regarding the transi-
tion; 
‘‘(II) the transfer of relevant medical records; 
‘‘(III) coordination of care between providers; 
‘‘(IV) the continued treatment of chronic or cur-
rent episodes of care (by means including medication, 
subspecialty care, and ancillary services); and 
‘‘(V) any other action the Secretary determines 
is necessary. 
‘‘(c) EPISODES OF CARE.—(1) The Secretary shall en-
sure that, at the election of an eligible veteran who receives 
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 services 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 determined necessary by the 
provider as part of the treatment recommended in the 
course of such care or services. In making such determina-
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tion with respect to necessary specialty and ancillary serv-
ices provided by a network provider, the network provider 
shall consult with the Secretary, acting through the pro-
gram office of the appropriate medical facility. 
‘‘(2) In cases of episodes of care that the Secretary de-
termines case management to be appropriate, the Secretary 
shall provide case management to an eligible veteran who 
receives hospital care, medical services, or extended care 
services from a network provider for such episodes of care. 
The Secretary may provide such case management through 
the Veterans Health Administration or through an entity 
that manages the operations of the regional networks pursu-
ant 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 Secretary 
shall— 
‘‘(i) negotiate rates for the furnishing of care and 
services under this section; and 
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‘‘(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 ne-
gotiated 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 Security 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 Medi-
care Program under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.) for the same care or services. 
‘‘(ii) In determining the rates under the Medicare Pro-
gram 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 applied 
to such provider of services may not be less than 1.00. 
‘‘(C) In carrying out paragraph (2), the Secretary 
may incorporate the use of value-based reimbursement mod-
els to promote the provision of high-quality care. 
‘‘(3)(A) With respect to the furnishing of care or serv-
ices under this section to an eligible veteran who resides 
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in a highly rural area (as defined under the rural-urban 
commuting area codes developed by the Secretary of Agri-
culture 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 De-
partment of Veterans Affairs will be followed, except 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 effective 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 successor agree-
ment. 
‘‘(D) With respect to furnishing care or services under 
this section in a location in which the Secretary determines 
that adjusting the rate paid by the United States as de-
scribed in paragraph (2)(B) is appropriate, the Secretary 
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 
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exception to the rates paid by the United States under the 
Medicare Program under title XVIII of the Social Security 
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 Medi-
care Program under title XVIII of the Social Security 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 Fed-
eral entity, the Secretary may negotiate a rate that is more 
than the rate paid by the United States as described in 
paragraph (2)(B). 
‘‘(4) For the furnishing of care or services pursuant 
to a contract or agreement under paragraph (1), a network 
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 
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 
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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 sub-
section, 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— 
‘‘(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. 
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‘‘(3) Notwithstanding chapter 39 of title 31 or any 
other provision of law, the covered payer shall pay a covered 
claimant for hospital care, medical services, or extended 
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 cal-
endar 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 calendar 
days after receiving the claim; or 
‘‘(ii) in the case of a clean claim submitted to 
the covered payer electronically, not later than 30 cal-
endar 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 
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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 appropriate 
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 addi-
tion 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 over-
due; 
‘‘(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 published 
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 penalty amount. 
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‘‘(6)(A) If the covered payer overpays a covered claim-
ant 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 covered 
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 payment 
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. 
‘‘(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). 
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‘‘(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 deduction 
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 vet-
eran under this section may not seek any payment for such 
care or services from the eligible veteran. 
‘‘(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 be-
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fore a covered payer makes a payment for such care 
or services; and 
‘‘(B) the Secretary may require that the network 
provider attests to such care or services so provided 
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 para-
graph (1) may not exceed the amount of the copayment that 
would be payable by such eligible veteran 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. 
‘‘(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 
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from a health-plan contract described in section 1705A in 
accordance with such section 1729. 
‘‘(g) MEDICAL RECORDS.—(1) The Secretary shall en-
sure that any network provider that furnishes care or serv-
ices 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 re-
quire that any payment by the Secretary to the eligi-
ble provider be contingent on such provision of med-
ical records. 
‘‘(2) To the extent practicable, the Secretary shall sub-
mit to a network provider that furnishes care or services 
under this section to an eligible veteran the medical records 
of such eligible veteran that are maintained by the Depart-
ment 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-
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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 Depart-
ment, or successor system, for the purpose of fur-
nishing 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 substan-
tially similar to the manner in which the network provider 
submits prescriptions to retail pharmacies. 
‘‘(2) Nothing in this section shall be construed to affect 
the process of the Department for filling and paying for 
prescription medications. 
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‘‘(j) QUALITY OF CARE.—In carrying out this section, 
the Secretary shall use the quality of care standards set 
forth or used by the Centers for Medicare & Medicaid Serv-
ices 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 Service 
Network and medical facility of the Department to furnish 
care or services under this chapter. Each such assessment 
shall— 
‘‘(A) identify gaps in furnishing such care or 
services at such Veterans Integrated Service Network 
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; 
‘‘(ii) making changes in the way such care 
and services are furnished at such Veterans Inte-
grated Service Network or medical facility, in-
cluding but not limited to— 
‘‘(I) extending hours of operation; 
‘‘(II) adding personnel; or 
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‘‘(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 otherwise 
devoid of commercial health care providers or from 
which such providers are at a risk of leaving. 
‘‘(2) The Secretary shall submit each assessment under 
paragraph (1) to the Committees on Veterans’ Affairs of the 
House of Representatives and the Senate and shall make 
each such assessment publicly available. 
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‘‘(l) ALLOCATION OF FUNDS.—The Secretary shall de-
velop a plan for the allocation of funds in the Medical Com-
munity Care account. 
‘‘(m) REPORTS ON RATES.—Not later than December 
31, 2019, and annually thereafter during each of the subse-
quent three years, the Secretary shall submit to the Commit-
tees on Veterans’ Affairs of the House of Representatives 
and the Senate a report detailing, for the fiscal year pre-
ceding 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 de-
scribed 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 covered 
payer of expenses for hospital care or medical 
services furnished under this section; 
‘‘(B) that contains substantially all of the 
required elements necessary for accurate adju-
dication, without requiring additional informa-
tion from the network provider; and 
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‘‘(C) in such a nationally recognized format 
as may be prescribed by the Secretary for pur-
poses of paying claims for hospital care or med-
ical 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 con-
tractor 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 re-
spect to a claim made by a network provider to 
the contractor for purposes of payment by the 
contractor of expenses for hospital care or med-
ical services furnished under this section; or 
‘‘(B) the Secretary with respect to— 
‘‘(i) a claim made by a network pro-
vider to the Secretary for purposes of pay-
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ment by the Secretary of expenses for hos-
pital care or medical services furnished 
under this section; and 
‘‘(ii) a claim made by a regional net-
work operated by a contractor pursuant to 
subsection (a)(4)(B) for purposes of reim-
bursement for a payment described by sub-
paragraph (A). 
‘‘(4) The term ‘eligible veteran’ means a veteran 
who— 
‘‘(A) is enrolled in the patient enrollment 
system of the Department established and oper-
ated under section 1705(a) of this title; and 
‘‘(B) has— 
‘‘(i) been furnished hospital care or 
medical services at or through a Depart-
ment facility on at least one occasion dur-
ing the two-year period preceding the date 
of the determination of eligibility; or 
‘‘(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 
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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 Access, 
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 following: 
‘‘or the date on which the Secretary certifies to the 
Committees on Veterans’ Affairs of the House of Rep-
resentatives and the Senate that the Secretary is fully 
implementing section 1703A of title 38, United States 
Code, whichever occurs first’’; and 
(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 following 
new paragraphs: 
‘‘(11) The term ‘network provider’ means any of 
the following health care providers that have entered 
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into a contract or agreement under which the pro-
vider agrees to furnish care and services to eligible 
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 Social 
Security Act (42 U.S.C. 1396d(l)(2)(B))). 
‘‘(D) The Department of Defense. 
‘‘(E) The Indian Health Service. 
‘‘(F) Any health care provider that is an 
academic affiliate of the Department. 
‘‘(G) Any health care provider not otherwise 
covered under any of subparagraphs (A) through 
(F) that meets criteria established by the Sec-
retary for purposes of such section. 
‘‘(12) The term ‘VA Care in the Community Pro-
gram’ means the program under which the Secretary 
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furnishes hospital care or medical services to veterans 
through network providers pursuant to section 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 Veterans 
Affairs under contracts and agreements for the provision 
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 agree-
ments. 
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 following 
new section: 
‘‘§ 1703B. Veterans Care Agreements with non-network 
providers 
‘‘(a) VETERANS CARE AGREEMENTS.—(1) In addition 
to furnishing hospital care, medical services, or extended 
care services under this chapter at facilities of the Depart-
ment or under contracts or agreements entered into pursu-
ant to section 1703A of this title or any other provision 
of law other than this section, the Secretary may furnish 
such care and services to eligible veterans through the use 
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of agreements, to be known as ‘Veterans Care Agreements’, 
entered into under this section by the Secretary 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 fa-
cility 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 provider 
under a contract or agreement entered into pursuant 
to a provision of law other than this section. 
‘‘(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 
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‘‘(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 review 
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 Department facility, 
or enter into an agreement under section 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 
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 Vet-
erans Care Agreement under subparagraph (A) as follows: 
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‘‘(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 Agreement 
under this section if the Secretary determines that the pro-
vider 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 the 
provider enters into the Veterans Care Agreement does 
not exceed— 
‘‘(A) $5,000,000 (as adjusted in a manner 
similar to amounts adjusted pursuant to section 
5312 of this title), in the case of a provider that 
furnishes homemaker or home health aide serv-
ices; or 
‘‘(B) $2,000,000 (as so adjusted), in the case 
of any other provider. 
‘‘(2) The provider is not a network provider and 
does not otherwise provide hospital care, medical serv-
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ices, or extended care services to patients pursuant to 
a contract entered into with the Department. 
‘‘(3) The provider is— 
‘‘(A) a provider of services that has enrolled 
and entered into a provider agreement under sec-
tion 1866(a) of the Social Security Act (42 
U.S.C. 1395cc(a)); 
‘‘(B) a physician or supplier that has en-
rolled and entered into a participation agree-
ment under section 1842(h) of such Act (42 
U.S.C. 1395u(h)); 
‘‘(C) a provider of items and services receiv-
ing 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; 
‘‘(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 de-
fined 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). 
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‘‘(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 pro-
viders to enter into Veterans Care Agreements under this 
section that shall, at a minimum, set forth the following: 
‘‘(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 approval 
and denial of certifications and the revocation of cer-
tifications. 
‘‘(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 Regu-
lations, or any successor regulation. 
‘‘(D) Requirement for denial or revocation of cer-
tification if the Secretary determines that the other-
wise 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. 
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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 Man-
agement, 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 
the Secretary determines that such exclusion is appro-
priate. 
‘‘(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 Gov-
ernment that an eligible provider has completed by reason 
of being a provider described in any of subparagraphs (A) 
through (E) of subsection (b)(4). 
‘‘(3) The Secretary shall— 
‘‘(A) verify upon enrollment, and annually 
thereafter, that eligible providers have not been ex-
cluded from participation in other federally funded 
health care programs; and 
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‘‘(B) submit to the Committees on Veterans’ Af-
fairs of the House of Representatives and the Senate 
an annual report on the results of such verifications. 
‘‘(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 entered 
into under such section. 
‘‘(e) EXCLUSION OF CERTAIN FEDERAL CONTRACTING 
PROVISIONS.—(1) Notwithstanding any other provision of 
law, the Secretary may enter into a Veterans Care Agree-
ment 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- 
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 Med-
icaid 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: 
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‘‘(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 section. 
‘‘(iii) Section 4705 or 4712 of title 41, and any 
other applicable law regarding the protection of whis-
tleblowers. 
‘‘(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-network pro-
vider in providing care or services through an agree-
ment 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-
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 sec-
tion. 
‘‘(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 provider 
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as the Secretary may specify for the purposes of this section, 
if the Secretary determines necessary. 
‘‘(g) DISPUTES.—(1) The Secretary shall establish ad-
ministrative procedures for providers with which the Sec-
retary 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 procedures 
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 serv-
ices are furnished to an eligible veteran pursuant to a Vet-
erans Care Agreement, any part of such care or services 
is furnished by a medical provider who is not an eligible 
non-network provider or a network provider, the Secretary 
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). 
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‘‘(i) ANNUAL REPORTS.—(1) Not later than December 
31 of the year following the fiscal year in which the Sec-
retary first enters into a Veterans Care Agreement under 
this section, and each year thereafter, the Secretary shall 
submit to the appropriate congressional committees an an-
nual report that includes a list of all Veterans Care Agree-
ments 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 section, 
the Secretary shall use the quality of care standards set 
forth or used by the Centers for Medicare & Medicaid Serv-
ices 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 Agree-
ment to an official of the Department at a level not below 
the Director of a Veterans Integrated Service Network 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 Senate; and 
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‘‘(B) the Committees on Appropriations of 
the House of Representatives and the Senate. 
‘‘(2) The term ‘eligible veteran’ has the meaning 
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 section 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 
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 paragraph: 
‘‘(4)(A) An agreement under this section may be en-
tered into without regard to any law that would require 
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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 per-
son to civil or criminal penalties. 
‘‘(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 
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on which the regulations prescribed by the Secretary 
of Veterans Affairs to implement such amendments 
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 im-
plementation date specified in section 108(a), the Chief In-
formation 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 established 
in section 1703A of title 38, United States Code, as added 
by section 102, and under Veterans Care Agreements estab-
lished 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. 
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(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 
of the date of the enactment of this Act, including the 
use of contractors to perform audits through data 
analytics, to determine the appropriateness and accu-
racy of claims of providers and to ensure program in-
tegrity 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 cri-
teria: 
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(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 privacy 
services and architectural requirements relating to se-
curity and privacy based on a thorough risk assess-
ment 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. 
(4) Such system shall provide assurance that the 
prioritized information security and privacy require-
ments of such system— 
(A) are correctly implemented in the design 
and implementation of such system through the 
systems development lifecycle; and 
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(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 
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. 
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(3) The term ‘‘secure development requirements’’ 
means, with respect to the information technology sys-
tem established under subsection (a), activities that 
are required to be completed during the system devel-
opment lifecycle of such interface, such as secure cod-
ing 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 Adminis-
tration, Medical Community Care account. 
(b) TRANSFER OF AMOUNTS.— 
(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: 
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(A) The date that is one year after the date 
of the enactment of this Act. 
(B) The date on which the Secretary of Vet-
erans Affairs submits to the Committees on Vet-
erans’ Affairs of the Senate and the House of 
Representatives the certification required by sec-
tion 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 repealed. 
(B) 
CONFORMING
AMENDMENT.—Section 
4003 of the Surface Transportation and Veterans 
Health Care Choice Improvement Act of 2015 
(Public Law 114–41; 38 U.S.C. 1701 note) is 
amended by striking ‘‘for non-Department pro-
vider programs (as defined in section 2(d))’’ and 
all that follows through ‘‘1802)’’ and inserting 
the following: ‘‘for the VA Care in the Commu-
nity 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’’. 
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(c) VA CARE
IN
THE COMMUNITY PROGRAM DE-
FINED.—In this section, the term ‘‘VA Care in the Commu-
nity Program’’ has the meaning given that term in section 
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 603of title 38, United 
States Code, is amended by adding at the end the fol-
lowing 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 
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 
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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 Program’’. 
(B) READJUSTMENT COUNSELING.—Section 
1712A(e)(1) of such title is amended by striking 
‘‘(under sections 1703(a)(2) and 1710(a)(1)(B) 
of this title)’’ and inserting ‘‘(under the VA Care 
in the Community Program)’’. 
(C) DEATH
IN
DEPARTMENT
FACILITY.— 
Section 2303(a)(2)(B)(i) of such title is amended 
by striking ‘‘in accordance with section 1703 of 
this title’’ and inserting ‘‘under the VA Care in 
the Community Program’’. 
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(D) MEDICARE PROVIDER AGREEMENTS.— 
Section 1866(a)(1)(L) of the Social Security Act 
(42 U.S.C. 1395cc(a)(1)(L)) is amended— 
(i) by striking ‘‘under section 1703 of 
title 38’’ and inserting ‘‘under the VA Care 
in the Community Program (as defined in 
section 1701(12) of title 38, United States 
Code)’’; and 
(ii) by striking ‘‘such section’’ and in-
serting ‘‘such program’’. 
(b) REPEAL
OF
AUTHORITY
TO
CONTRACT
FOR 
SCARCE MEDICAL SPECIALISTS.— 
(1) IN
GENERAL.—Section 7409 of title 38, 
United States Code, is repealed. 
(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 sub-
sections (a) and (b) shall take effect on the date on which 
the Secretary certifies to the Committees on Veterans’ Af-
fairs 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. 
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SEC. 108. IMPLEMENTATION AND TRANSITION. 
(a) IMPLEMENTATION.—The Secretary of Veterans Af-
fairs 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 regulations 
to implement such sections and publish such regulations 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, respectively, the 
Secretary of Veterans Affairs shall— 
(1) certify to the Committees on Veterans’ Affairs 
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 sec-
tion 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 
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(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. 
SEC. 109. TRANSPLANT PROCEDURES WITH LIVE DONORS 
AND RELATED SERVICES. 
(a) IN GENERAL.—Subchapter I of chapter 17 of title 
38, United States Code, is further amended by inserting 
after section 1703B, as added by section 103, the following 
new section: 
‘‘§ 1703C. Transplant procedures with live donors and 
related services 
‘‘(a) IN GENERAL.—Subject to subsections (b) and (c), 
in a case in which a veteran is eligible for a transplant 
procedure from the Department, the Secretary may provide 
for an operation on a live donor to carry out such procedure 
for such veteran, notwithstanding that the live donor may 
not be eligible for health care from the Department. 
‘‘(b) OTHER SERVICES.—Subject to the availability of 
appropriations for such purpose, the Secretary shall furnish 
to a live donor any care or services before and after con-
ducting the transplant procedure under subsection (a) that 
may be required in connection with such procedure. 
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‘‘(c) USE OF NON-DEPARTMENT FACILITIES.—(1) In 
carrying out this subsection, the Secretary may provide for 
the operation described in subsection (a) on a live donor 
and furnish to the live donor the care and services described 
in subsection (b) at a non-Department facility pursuant to 
an agreement entered into by the Secretary under this sec-
tion. The live donor shall be deemed to be an individual 
eligible for hospital care and medical services at a non-De-
partment facility pursuant to such an agreement solely for 
the purposes of receiving such operation, care, and services 
at the non-Department facility. 
‘‘(2) The Secretary may only provide for an operation 
at a non-Department of Veterans Affairs transplant center 
pursuant to paragraph (1) if the center is in compliance 
with regulations prescribed by the Centers for Medicare & 
Medicaid Services applicable to transplant centers.’’. 
(b) CLERICAL AMENDMENT.—The table of section at 
the beginning of such chapter is further amended by insert-
ing after the item relating to section 1703B, as added by 
section 103, the following new item: 
‘‘1703C. Transplant procedures with live donors and related services.’’. 
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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 ambulance 
services for an individual, the Secretary shall treat such 
services as emergency services for which reimbursement may 
be made under this section if the Secretary determines 
that— 
‘‘(A) the request for ambulance services was 
made as a result of the sudden onset of a medical con-
dition of such a nature that a prudent layperson who 
possesses an average knowledge of health and medi-
cine— 
‘‘(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 jeopardy, 
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the serious impairment of bodily functions, 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 sub-
section (a) shall take effect on the date of the enactment 
of this Act and shall apply with respect to ambulance serv-
ices provided on or after January 1, 2019. 
SEC. 202. IMPROVEMENT OF CARE COORDINATION FOR 
VETERANS THROUGH EXCHANGE OF CERTAIN 
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: 
‘‘(I) To a public or private health care pro-
vider in order to provide treatment or health 
care to a shared patient. 
‘‘(J) To a third party in order to recover or 
collect reasonable charges for care furnished to a 
veteran for a non-service-connected disability 
pursuant to section 1729 of this title or section 
1 of Public Law 87–693 (42 U.S.C. 2651).’’; and 
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(2) by adding at the end the following new para-
graph: 
‘‘(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 re-
cover under this section shall not affect any copay-
ment amount a veteran is otherwise obligated to pay 
under this chapter.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall take effect on the date of the enactment 
of this Act and apply with respect to a copayment obliga-
tion 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 auto-
matic data processing or information technology improve-
ments)’’ 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.—(1) The Secretary 
shall establish for each Department facility— 
‘‘(A) in accordance with paragraph (2), stand-
ardized performance standards based on nationally 
recognized relative value unit production standards 
applicable to each specific profession in order to 
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evaluate clinical productivity at the provider and fa-
cility level; 
‘‘(B) remediation plans to address low clinical 
productivity and clinical inefficiency; and 
‘‘(C) an ongoing process to systematically review 
the content, implementation, and outcome of the plans 
developed under subparagraph (B). 
‘‘(2) In establishing the performance standards under 
paragraph (1)(A), the Secretary may— 
‘‘(A) incorporate values-based productivity mod-
els; and 
‘‘(B) take into account non-clinical duties, in-
cluding with respect to training and research. 
‘‘(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 prac-
tice registered nurse, and a physician’s assistant act-
ing 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 procedure.’’. 
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(A) IN
GENERAL.—A covered health care 
provider is not required under paragraph (1)(B) 
to submit an opioid prescription directly to a 
pharmacy of the Department if— 
(i) the health care provider determines 
that there is an immediate medical need for 
the prescription, including an urgent or 
emergent prescription or a prescription dis-
pensed as part of an opioid treatment pro-
gram that provides office-based medications; 
and 
(ii)(I) following an inquiry into the 
matter, a pharmacy of the Department no-
tifies the health care provider that it cannot 
fill the prescription in a timely manner; or 
(II) the health care provider deter-
mines that the requirement under para-
graph (1)(B) would impose an undue hard-
ship on the veteran, including with respect 
to travel distances, as determined by the 
Secretary. 
(B) NOTIFICATION TO DEPARTMENT.—If a 
covered health care provider uses an exception 
under subparagraph (A) with respect to an 
opioid prescription for a veteran, the health care 
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