Title: Veterans Access to Long Term Care and Health Services Act
Policy area: Armed Forces and National Security

Summary:
Veterans Access to Long Term Care and Health Services Act
This bill authorizes the Department of Veterans Affairs (VA), if unable to furnish hospital care, medical services, or extended care at VA facilities or under other authorized contracts or sharing agreements, to enter into a Veterans Care Agreement (VCA) with an eligible provider to furnish such care and services.
The VA shall review VCAs exceeding $1 million annually at least once every two years.
The VA shall establish a process for the certification of eligible providers.
An eligible provider is:
The VA shall establish a system or systems to monitor the quality of care and services furnished to veterans, which shall be used in assessing whether to renew a VCA.
A VCA may be made with a health care provider to provide veterans with nursing home care.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4113 Introduced in House (IH)]

<DOC>






115th CONGRESS
  1st Session
                                H. R. 4113

   To amend title 38, United States Code, to allow the Secretary of 
 Veterans Affairs to enter into certain agreements with non-Department 
   of Veterans Affairs health care providers if the Secretary is not 
feasibly able to provide health care in facilities of the Department or 
    through contracts or sharing agreements, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 24, 2017

 Mr. Poliquin introduced the following bill; which was referred to the 
                     Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
   To amend title 38, United States Code, to allow the Secretary of 
 Veterans Affairs to enter into certain agreements with non-Department 
   of Veterans Affairs health care providers if the Secretary is not 
feasibly able to provide health care in facilities of the Department or 
    through contracts or sharing agreements, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans Access to Long Term Care 
and Health Services Act''.

SEC. 2. PURPOSE.

    The purpose of this Act is--
            (1) to maintain the access of veterans to high-quality 
        hospital care, medical services, and extended care if that care 
        is not available directly from the Department of Veterans 
        Affairs;
            (2) to continue to allow the use by the Department of 
        agreements covered by the Federal Acquisition Regulation and 
        agreements that are not covered by such regulation, similar to 
        those agreements used under the original Medicare fee-for-
        service program (Medicare Parts A and B), if it is not 
        practicable to contract for the care needed by veterans through 
        an agreement covered by such regulation;
            (3) to address the fact that individual health care 
        providers, especially smaller providers in rural areas, may not 
        be willing to accept veterans as patients when doing so would 
        require the significant time and administrative requirements in 
        connection with entering into agreements with the Department 
        that are covered by such regulation;
            (4) to address the deficiencies in current law regarding 
        agreements entered into by the Department that have raised 
        legal issues; and
            (5) to ensure that agreements that are not covered by such 
        regulation include robust terms and conditions that address the 
        quality of health care for veterans, oversight of the provision 
        of such health care, and protections for taxpayers.

SEC. 3. AUTHORIZATION OF AGREEMENTS BETWEEN THE DEPARTMENT OF VETERANS 
              AFFAIRS AND NON-DEPARTMENT HEALTH CARE PROVIDERS.

    (a) In General.--Subchapter I of chapter 17 of title 38, United 
States Code, is amended by adding after section 1703 the following new 
section:
``Sec. 1703A. Veterans Care Agreements with certain health care 
              providers
    ``(a) Agreements To Furnish Care.--(1) If the Secretary is not 
feasibly able to furnish hospital care, medical services, or extended 
care under this chapter at facilities of the Department or under 
contracts or sharing agreements entered into under authorities other 
than this section, the Secretary may furnish such care and services by 
entering into agreements under this section with eligible providers 
that are certified under subsection (c). An agreement entered into 
under this section may be referred to as a `Veterans Care Agreement'.
    ``(2) The Secretary is not feasibly able to furnish care or 
services as described in paragraph (1) if the Secretary determines that 
the medical condition of the veteran, the travel involved, the nature 
of the care or services required, or a combination of those factors 
make the use of facilities of the Department, contracts, or sharing 
agreements impracticable or inadvisable.
    ``(3) Eligibility of a veteran under this section for the care or 
services described in paragraph (1) shall be determined as if such care 
or services were furnished in a facility of the Department and 
provisions of this title applicable to veterans receiving such care or 
services in a facility of the Department shall apply to veterans 
receiving such care or services under this section.
    ``(b) Eligible Providers.--For purposes of this section, an 
eligible provider is one of the following:
            ``(1) A provider of services that has enrolled and entered 
        into a provider agreement under section 1866(a) of the Social 
        Security Act (42 U.S.C. 1395cc(a)).
            ``(2) A physician or supplier that has enrolled and entered 
        into a participation agreement under section 1842(h) of such 
        Act (42 U.S.C. 1395u(h)).
            ``(3) A provider of items and services receiving 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.
            ``(4) A provider that is--
                    ``(A) 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
                    ``(B) a center for independent living (as defined 
                in section 702 of the Rehabilitation Act of 1973 (29 
                U.S.C. 796a)).
            ``(5) Such other health care providers as the Secretary 
        considers appropriate for purposes of this section.
    ``(c) Certification of Eligible Providers.--(1) The Secretary shall 
establish a process for the certification of eligible providers under 
this section that shall, at a minimum, set forth the following:
            ``(A) Procedures for the submittal of applications for 
        certification and deadlines for actions taken by the Secretary 
        with respect to such applications.
            ``(B) Standards and procedures for approval and denial of 
        certification, duration of certification, revocation of 
        certification, and recertification.
            ``(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 section 1866(j)(2)(B) of the 
        Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and the 
        standards set forth under section 9.104 of title 48, Code of 
        Federal Regulations, or any successor regulation.
    ``(2) The Secretary shall deny or revoke certification to an 
eligible provider under this subsection if the Secretary determines 
that the eligible provider is currently--
            ``(A) excluded from participation in a Federal 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
            ``(B) identified as an excluded source on the list 
        maintained in the System for Award Management, or any successor 
        system.
    ``(d) Terms of Agreements.--Each agreement entered into with an 
eligible provider under this section shall include provisions requiring 
the eligible provider to do the following:
            ``(1) To accept payment for care and services furnished 
        under this section at rates established by the Secretary for 
        purposes of this section, which shall be, to the extent 
        practicable, the rates paid by the United States for such care 
        and services to providers of services and suppliers under the 
        Medicare program under title XVIII of the Social Security Act 
        (42 U.S.C. 1395 et seq.).
            ``(2) To accept payment under paragraph (1) as payment in 
        full for care and services furnished under this section and to 
        not seek any payment for such care and services from the 
        recipient of such care and services.
            ``(3) To furnish under this section only the care and 
        services authorized by the Department under this section unless 
        the eligible provider receives prior written consent from the 
        Department to furnish care or services outside the scope of 
        such authorization.
            ``(4) To bill the Department for care and services 
        furnished under this section in accordance with a methodology 
        established by the Secretary for purposes of this section.
            ``(5) Not to seek to recover or collect from a health-plan 
        contract or third party, as those terms are defined in section 
        1729 of this title, for any care or services for which payment 
        is made by the Department under this section.
            ``(6) To provide medical records for veterans furnished 
        care or services under this section to the Department in a 
        timeframe and format specified by the Secretary for purposes of 
        this section.
            ``(7) To meet such other terms and conditions, including 
        quality of care assurance standards, as the Secretary may 
        specify for purposes of this section.
    ``(e) Termination of Agreements.--(1) An eligible provider may 
terminate an agreement with the Secretary under this section at such 
time and upon such notice to the Secretary as the Secretary may specify 
for purposes of this section.
    ``(2) The Secretary may terminate an agreement with an eligible 
provider under this section at such time and upon such notice to the 
eligible provider as the Secretary may specify for purposes of this 
section, if the Secretary--
            ``(A) determines that the eligible provider failed to 
        comply substantially with the provisions of the agreement or 
        with the provisions of this section and the regulations 
        prescribed thereunder;
            ``(B) determines that the eligible provider is--
                    ``(i) excluded from participation in a Federal 
                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;
            ``(C) ascertains that the eligible provider has been 
        convicted of a felony or other serious offense under Federal or 
        State law and determines that the continued participation of 
        the eligible provider would be detrimental to the best 
        interests of veterans or the Department; or
            ``(D) determines that it is reasonable to terminate the 
        agreement based on the health care needs of a veteran or 
        veterans.
    ``(f) Periodic Review of Certain Agreements.--(1) Not less 
frequently than once every two years, the Secretary shall review each 
Veterans Care Agreement of material size entered into during the two-
year period preceding the review to determine whether it is feasible 
and advisable to furnish the hospital care, medical services, or 
extended care furnished under such agreement at facilities of the 
Department or through contracts or sharing agreements entered into 
under authorities other than this section.
    ``(2)(A) Subject to subparagraph (B), a Veterans Care Agreement is 
of material size as determined by the Secretary for purposes of this 
section.
    ``(B) A Veterans Care Agreement entered into after September 30, 
2018, for the purchase of extended care services is of material size if 
the purchase of such services under the agreement exceeds $1,000,000 
annually. The Secretary may adjust such amount to account for changes 
in the cost of health care based upon recognized health care market 
surveys and other available data and shall publish any such adjustments 
in the Federal Register.
    ``(g) Treatment of Certain Laws.--(1) An agreement under this 
section may be entered 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.
    ``(2)(A) Except as provided in subparagraph (B) and unless 
otherwise provided in this section or regulations prescribed pursuant 
to this section, an eligible provider that enters into an agreement 
under this section is not subject to, in the carrying out of the 
agreement, any law that an eligible provider described in subsection 
(b)(1), (b)(2), or (b)(3) is not subject to 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.).
    ``(B) The exclusion under subparagraph (A) does not apply to laws 
regarding integrity, ethics, fraud, or that subject a person to civil 
or criminal penalties.
    ``(3) Title VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et 
seq.) shall apply with respect to an eligible provider that enters into 
an agreement under this section to the same extent as such title 
applies with respect to the eligible provider in providing care or 
services through an agreement or arrangement other than under this 
section.
    ``(h) Monitoring of Quality of Care.--The Secretary shall establish 
a system or systems, consistent with survey and certification 
procedures used by the Centers for Medicare & Medicaid Services and 
State survey agencies to the extent practicable--
            ``(1) to monitor the quality of care and services furnished 
        to veterans under this section; and
            ``(2) to assess the quality of care and services furnished 
        by an eligible provider for purposes of determining whether to 
        renew an agreement under this section with the eligible 
        provider.
    ``(i) Dispute Resolution.--(1) The Secretary shall establish 
administrative procedures for eligible providers with which the 
Secretary has entered an agreement under this section to present any 
dispute arising under or related to the agreement.
    ``(2) Before using any dispute resolution mechanism under chapter 
71 of title 41 with respect to a dispute arising under an agreement 
under this section, an eligible provider must first exhaust the 
administrative procedures established by the Secretary under paragraph 
(1).''.
    (b) Regulations.--The Secretary of Veterans Affairs shall prescribe 
an interim final rule to carry out section 1703A of such title, as 
added by subsection (a), not later than one year after the date of the 
enactment of this Act.
    (c) Clerical Amendment.--The table of sections at the beginning of 
chapter 17 of such title is amended by inserting after the item related 
to section 1703 the following new item:

``1703A. Veterans Care Agreements with certain health care 
                            providers.''.

SEC. 4. MODIFICATION OF AUTHORITY TO ENTER INTO AGREEMENTS TO PROVIDE 
              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 striking ``a contract (or agreement under 
        section 1720(c)(1) of this title)'' and inserting ``an 
        agreement''.
            (2) Payment.--Paragraph (2) of such section is amended by 
        striking ``contract (or agreement)'' each place it appears and 
        inserting ``agreement''.
    (b) Exclusion of Certain Federal Contracting Provisions.--Such 
section is amended by adding at the end the following new paragraph:
    ``(4)(A) An agreement under this section may be entered 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 regulations prescribed 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 that a 
provider described in subparagraph (D) is not subject to 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.
    ``(C) Title VII of the Civil Rights Act of 1964 (42 U.S.C. 2000e et 
seq.) shall apply with respect to any State home that enters into an 
agreement under this section.
    ``(D) A provider described in this subparagraph is one of the 
following:
            ``(i) A provider of services that has enrolled and entered 
        into a provider agreement under section 1866(a) of the Social 
        Security Act (42 U.S.C. 1395cc(a)).
            ``(ii) A physician or supplier that has enrolled and 
        entered into a participation agreement under section 1842(h) of 
        such Act (42 U.S.C. 1395u(h)).
            ``(iii) A provider of items and services receiving 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) Effective Date.--The amendments made by this section shall 
apply to agreements entered into under section 1745 of such title on 
and after the date that is 30 days after the date of the enactment of 
this Act.
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