Title: Improving Oversight of the Veterans Community Care Providers Act of 2022
Policy area: Armed Forces and National Security

Summary:
Improving Oversight of the Veterans Community Care Providers Act of 2022
This bill requires the Veterans Health Administration to carry out a plan to improve the methods by which the Department of Veterans Affairs (VA) identifies health care providers that are not eligible to participate in the Veterans Community Care Program.
The VA must certify to Congress it has implemented the plan not later than December 31, 2022.

[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 7277 Introduced in House (IH)]

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117th CONGRESS
  2d Session
                                H. R. 7277

   To improve the methods by which the Secretary of Veterans Affairs 
 identifies health care providers that are not eligible to participate 
                in the Veterans Community Care Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 29, 2022

 Mr. Pappas (for himself and Mr. Mann) introduced the following bill; 
        which was referred to the Committee on Veterans' Affairs

_______________________________________________________________________

                                 A BILL


 
   To improve the methods by which the Secretary of Veterans Affairs 
 identifies health care providers that are not eligible to participate 
                in the Veterans Community Care Program.

    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 ``Improving Oversight of the Veterans 
Community Care Providers Act of 2022''.

SEC. 2. IDENTIFICATION OF HEALTH CARE PROVIDERS THAT ARE NOT ELIGIBLE 
              TO PARTICIPATE IN VETERANS COMMUNITY CARE PROGRAM.

    (a) Plan.--
            (1) Requirement.--Beginning not later than 90 days after 
        the date of the enactment of this Act, the Secretary of 
        Veterans Affairs, acting through the Under Secretary for 
        Health, shall carry out a plan to improve the methods by which 
        the Secretary identifies health care providers that are not 
        eligible to participate in the Veterans Community Care Program.
            (2) Matters included.--The plan under paragraph (1) shall 
        include the following:
                    (A) Modifying the standard operating procedures of 
                the Office of Community Care of the Veterans Health 
                Administration regarding the exclusion of health care 
                providers from participating in the Veterans Community 
                Care Program to require the automated continuous 
                matching of health care providers in the Provider 
                Profile Management System of the Veterans Health 
                Administration, or such successor system, with covered 
                data systems using multiple unique identifiers, 
                including taxpayer identification number, national 
                provider identifier, Social Security number, and date 
                of birth.
                    (B) A fraud risk analysis conducted by the Office 
                of Community Care regarding the exclusion of health 
                care providers from participating in the Veterans 
                Community Care Program that includes--
                            (i) an assessment of the likelihood and 
                        impact of inherent fraud risks relating to the 
                        self-certification of State licenses and 
                        addresses provided by health care providers;
                            (ii) a determination of the fraud risk 
                        tolerance; and
                            (iii) an examination of the suitability of 
                        existing fraud controls.
                    (C) Any other matters the Under Secretary 
                determines will improve the oversight of health care 
                providers participating in the Veterans Community Care 
                Program.
    (b) Certification.--Not later than December 31, 2022, the Secretary 
shall certify to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate that the Secretary has implemented the 
plan under subsection (a).
    (c) Report.--Not later than January 31, 2023, the Secretary shall 
submit to the Committees on Veterans' Affairs of the House of 
Representatives and the Senate a report that--
            (1) describes the progress the Under Secretary has made in 
        carrying out the plan under subsection (a); and
            (2) includes recommendations for legislative action to 
        further improve the methods by which the Secretary identifies 
        health care providers that are not eligible to participate in 
        the Veterans Community Care Program.
    (d) Definitions.--In this section:
            (1) The term ``covered data systems'' means the following:
                    (A) The List of Excluded Individuals/Entities of 
                the Office of Inspector General of the Department of 
                Health and Human Services.
                    (B) The System for Award Management Exclusions list 
                described in part 9 of title 48, Code of Federal 
                Regulations, and part 180 of title 2 of such Code, or 
                successor regulations.
                    (C) The monthly deactivation file of the National 
                Plan and Provider Enumeration System of the Centers for 
                Medicare & Medicaid Services.
                    (D) The National Practitioner Data Bank established 
                pursuant to the Health Care Quality Improvement Act of 
                1986 (42 U.S.C. 11101 et seq.).
            (2) The term ``Veterans Community Care Program'' means the 
        program established under section 1703 of title 38, United 
        States Code.
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