Ҥ 1703. Veterans Community Care Program

“(a) In general.— (1) Subject to the availability of appropriations for such purpose and subject to paragraph (4), hospital care, medical services, and extended care services under this chapter shall be furnished to a covered veteran described in subsection (b) by health care providers specified in subsection (c) in accordance with this section.

“(2) The furnishing of care and services under this section may be referred to as the ‘Veterans Community Care Program’.

“(3) (A) In carrying out this section, the Secretary may develop categories of certain health care providers specified in subsection (c) for the purpose of providing a covered veteran hospital care, medical services, and extended care services when the covered veteran does not state a preference for a health care provider.

“(B) In developing categories of health care providers under subparagraph (A), the Secretary shall not—

“(i) prioritize or rank such categories in a manner that limits the options a covered veteran may have in selecting a health care provider specified in subsection (c); or

“(ii) direct a covered veteran to receive care or services from certain health care providers instead of other health care providers.

“(4) In carrying out this section, the Secretary shall not limit any hospital care, medical service, extended care service, or class of hospital care, medical service, or extended care service that are set forth in the Medical Benefits Package of the Department, as modified as determined by the Secretary.

“(b) Covered veterans.—For purposes of this section, a covered veteran is any veteran who—

“(1) (A) is enrolled in the patient enrollment system of the Department established and operated under section 1705 of this title; or

“(B) is not enrolled in such system but is otherwise entitled to hospital care, a medical service, or an extended care service under subsection (c)(2) of such section; and

“(2) (A) has been furnished hospital care or medical services under this chapter on at least one occasion during the preceding two-year period; or

“(B) requested a first-time appointment for hospital care or medical services at a Department facility.

“(c) Health care providers specified.—Health care providers specified in this subsection are the following:

“(1) Any health care provider 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 a program.

“(2) The Department of Defense.

“(3) The Indian Health Service.

“(4) 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))).

“(5) Any health care provider not otherwise covered under any of paragraphs (1) through (4) that meets criteria established by the Secretary for purposes of this section.

“(d) Contracts To establish networks of health care providers.— (1) The Secretary shall enter into consolidated, competitively bid contracts, which may be regional contracts, to establish networks of non-Department health care providers specified in paragraphs (1) and (5) of subsection (c) for contract purposes of—

“(A) providing sufficient access to hospital care, medical services, and extended care services under this section;

“(B) managing the operations of such health care providers; and

“(C) managing the delivery of hospital care, medical services, and extended care services under this section.

“(2) The Secretary may terminate a contract with an entity entered into under paragraph (1) at such time and upon such notice to the entity as the Secretary may specify for purposes of this section.

“(3) (A) Whenever the Secretary provides notice to an entity under paragraph (2) that the entity is failing to meet contractual obligations entered into under paragraph (1), the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a report on such failure and the decision of the Secretary to terminate the contract under paragraph (2).

“(B) Each report submitted under subparagraph (A) shall include the following:

“(i) An explanation of the reasons for terminating the contract.

“(ii) A description of the effect of the failure of the entity to meet contractual obligations and the termination of the contract, including with respect to cost, schedule, and requirements.

“(iii) A description of the actions taken by the Secretary to mitigate such failure and termination.

“(e) Coordination of care and services.— (1) The Secretary shall ensure that for each covered veteran seeking care or services under this section, a care coordination team is provided by a medical facility of the Department.

“(2) The Secretary shall ensure that each care coordination team provided under this section, with respect to a covered veteran, is responsible for the following:

“(A) Coordination and management of hospital care, medical services (including telemedicine), and extended care services furnished under this title, including the following:

“(i) Collaboration with the patient aligned care teams (PACT) within the medical facility of the Department; and

“(ii) Coordination within and across Veterans Integrated Service Networks with non-Department health care providers acting under a contract or agreement to furnish hospital care, a medical service, or an extended care service on behalf of the Department and who meets such terms and conditions as the Secretary may require.

“(B) Ensure continuity of care for the covered veteran to avoid any delay or lapse in care or services from an action or error of the Department or any individual of the care coordination team of the covered veteran.

“(C) Submitting information to the Secretary in furtherance of analysis conducted under section 1730B(a) of this title.

“(3) The Secretary shall develop an organizational construct for care coordination teams at medical facilities of the Department that may include the following individuals:

“(A) An employee of the Department who furnishes hospital care, a medical service, or an extended care service at the facility.

“(B) A non-Department health care provider acting under a contract or agreement to furnish hospital care, a medical service, or an extended care service on behalf of the Department and who meets such terms and conditions as the Secretary may require.

“(C) An employee of the Department or a health care provider described in subparagraph (B) who serves to seamlessly coordinate the delivery of hospital care, medical services, and extended care services to covered veterans.

“(f) Eligibility reform and conditions that require access to community care.— (1) Subject to the availability of appropriations, the Secretary shall furnish hospital care, medical services, and extended care services to a covered veteran, at the election of a covered veteran, through health care providers specified in subsection (c) as follows:

“(A) When a medical facility of the Department does not offer the hospital care, medical services, or extended care services the covered veteran requires.

“(B) When a medical facility of the Department cannot furnish or schedule an appointment for hospital care, medical services, or extended care services in accordance with access standards established under section 1703B of this title.

“(C) When the covered veteran and a referring clinician of the covered veteran agree that furnishing hospital care, medical services, or extended care services through a non-Department entity or provider would be in the best medical interest of the covered veteran, after consideration of the standards established under sections 1703B and 1703C of this title or due to a non-clinical reason, compelling circumstance, or other considerations that are in the best medical interest of the covered veteran.

“(2) Not later than 120 days after the date of the enactment of the Veterans Community Care and Access Act of 2017, the Secretary shall submit to the appropriate committees of Congress a report describing the guidelines and standards the Secretary intends to use to carry out paragraph (1) in accordance with sections 1703B and 1703C of this title.

“(g) Scheduling services.— (1) The Secretary shall ensure that services are established in order to schedule appointments for hospital care, medical services, and extended care services under this chapter.

“(2) (A) In carrying out paragraph (1), the Secretary shall determine whether services established under such paragraph should reside within the respective medical facility of the Department or reside with an entity with whom the Secretary enters into a contract for such services.

“(B) In carrying out subparagraph (A), the Secretary shall assess the following:

“(i) Whether a medical facility of the Department is currently managing scheduling services and the Secretary determines such medical facility has the capability to continue to manage scheduling.

“(ii) Whether a medical facility of the Department has the capacity to manage scheduling services based on the following:

“(I) An initial review of the medical facility to acquire scheduling service responsibilities and the preference of the medical facility to acquire such responsibilities.

“(II) The market area assessment currently underway pursuant to section 1730B(c) of this title.

“(III) The capacity of the medical facility to perform scheduling services that meet standards established under sections 1703B and 1703C of this title.

“(iii) Whether one or more contracts were in effect on the day before the date of the enactment of the Veterans Community Care and Access Act of 2017 that include scheduling services, as determined by the Secretary, and may be modified by the Secretary for services under this subsection.

“(h) Definitions.—In this section:

“(1) The term ‘appropriate committees of Congress’ means—

“(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

“(2) The term ‘clinician’ has the meaning given that term by the Centers for Medicare & Medicaid Services and includes Doctors of Medicine (MD), Doctors of Osteopathy (DO), Doctors of Dental Surgery or Dental Medicine (DMD/DDS), Doctors of Podiatry, Doctors of Optometry, Chiropractors, Physician Assistants (PA), Nurse Practitioners (NP), Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, and such other health professionals as the Secretary may specify for purposes of this section.

“(3) The term ‘medical facility of the Department’ includes a medical center, a community-based outpatient clinic, an outpatient clinic, or any other facility of the Department at which hospital care, medical services, or extended care services are furnished.”.

Ҥ 1730B. Quadrennial Veterans Health Administration review, management of high-performing integrated healthcare network, and market area assessments

“(a) Quadrennial Veterans Health Administration review.— (1) Not later than one year after the date of the enactment of the Veterans Community Care and Access Act of 2017 and not less frequently than once every four years thereafter, the Secretary shall conduct a comprehensive examination (to be known as a ‘quadrennial Veterans Health Administration review’) of programs and policies of the Department regarding the delivery of health care services and the need for health care services for veterans in future years.

“(2) The Secretary shall designate an individual in a Senior Executive Service position (as defined in section 3132(a) of title 5) or equivalent as the Director of the High-Performing Integrated Healthcare Network of the Department (in this section referred to as the ‘Director’) who shall be responsible for carrying out this section and advising the Secretary and the Under Secretary for Health on matters pertaining to this section.

“(3) Each quadrennial Veterans Health Administration review conducted under paragraph (1) shall include a strategic plan to meet future requirements and demand for hospital care, medical services, and extended care services under the laws administered by the Secretary that includes a five-year budget forecast for meeting such requirements and demand based on the information contained in the market area assessments conducted under subsection (c) and such other information as the Secretary considers appropriate.

“(4) In preparing the quadrennial Veterans Health Administration review under paragraph (1), including the strategic plan under paragraph (3), the Secretary shall—

“(A) consider the access and quality standards established under sections 1703B and 1703C of this title, respectively;

“(B) consider the needs of the Department to furnish health care services to veterans based on—

“(i) identified health care services that provide management of health conditions or disorders related to military service for which there is limited experience or access to such health care services from non-Department health care providers in the commercial market;

“(ii) the overall health of veterans throughout their lifespan; or

“(iii) such other services as the Secretary determines appropriate;

“(C) consult with key stakeholders within the Department, the heads of other Federal agencies, and other relevant governmental and nongovernmental entities, including State, local, and tribal government officials, members of Congress, veterans service organizations, private sector representatives, academics, and other policy experts;

“(D) identify emerging issues, trends, problems, and opportunities that could affect health care services furnished under the laws administered by the Secretary;

“(E) develop recommendations regarding both short- and long-term priorities for health care services furnished under the laws administered by the Secretary;

“(F) compare the Veterans Equitable Resource Allocation (VERA) system to other resource allocation systems or models for the purpose of analyzing the effectiveness of such systems in allocating resources to furnish hospital care, medical services, and extended care services to veterans; and

“(G) consider the work of the Center for Innovation for Care and Payment under section 1703F of this title with respect to research, development, and testing payment and service delivery models.

“(b) Management of high-Performing integrated healthcare network.— (1) The Director shall be responsible for the management, design, implementation, and assessment of the high-performing integrated healthcare network of the Department.

“(2) In managing, designing, implementing, and assessing the high-performing integrated healthcare network of the Department under this subsection, the Director shall be responsible for the following:

“(A) Overseeing the transformation and organizational change across the Department to achieve such high-performing integrated healthcare network.

“(B) Developing and implementing the quadrennial Veterans Health Administration review and strategic plan under subsection (a).

“(C) Overseeing the market area assessments performed under subsection (c).

“(D) Developing the capital infrastructure planning and procurement processes, whether minor or major construction projects or leases, in coordination with other offices of the Department.

“(E) Developing a multi-year budget process that is capable of forecasting future year budget requirements and projecting the cost of delivering health care services under a high-performing integrated healthcare network.

“(3) To ensure that the Director is able to carry out the responsibilities under paragraph (2), the Secretary shall ensure that coordination and information sharing occurs with other relevant offices of the Department, including the following offices:

“(A) The Office of Management.

“(B) The Office of Acquisition, Logistics and Construction.

“(C) The Office of Information and Technology.

“(4) In carrying out this subsection, the Director shall confer with the Director of the Defense Health Agency and consider best practices and recommendations from non-Department entities, including entities carrying out market area assessments under subsection (c), that have developed plans, implemented systems, or advised other healthcare systems.

“(5) (A) Not less frequently than once every three months, the Secretary or the Director shall brief the appropriate committees of Congress on the activities conducted under this subsection.

“(B) Each briefing conducted under subparagraph (A) shall include the following:

“(i) An assessment of any remediation or improvement conducted by the Department with respect to a medical service line of the Department that the Secretary has determined does not meet an access standard or standard for quality established under section 1703B or 1703C of this title, respectively, in providing hospital care, a medical service, or an extended care service, including the following:

“(I) An assessment of the factors that led the Secretary to make such determination.

“(II) An assessment of the medical service line in relation to the market area assessment most recently performed under subsection (c), particularly with respect to how it relates to the demand for the medical service line in the area and by veterans using a medical facility of the Department for such medical service line.

“(III) A plan with specific actions, and the time to complete them, to meet the access standards and standards for quality established under sections 1703B and 1703C of this title, respectively, which shall include consideration of—

“(aa) increasing personnel or temporary personnel assistance, including mobile deployment teams;

“(bb) special hiring incentives, including the Education Debt Reduction Program under subchapter VII of chapter 76 of this title and recruitment, relocation, and retention incentives;

“(cc) using direct hiring authority;

“(dd) providing improved training opportunities for staff;

“(ee) acquiring improved equipment;

“(ff) making structural modifications to the facility used by the medical service line;

“(gg) partnering with health care providers that have the capacity to meet the demand in the market area and meet access and quality standards established under sections 1703B and 1703C of this title; and

“(hh) such other actions as the Secretary considers appropriate.

“(ii) An assessment of the progress made by the Department with respect to the responsibilities of the Director under paragraph (2).

“(c) Market area assessments.— (1) Not less frequently than once every four years, the Secretary shall perform market area assessments regarding the health care services furnished under the laws administered by the Secretary.

“(2) Each market area assessment performed under paragraph (1) shall include the following:

“(A) An assessment of the demand for hospital care, medical services, and extended care services from the Department, disaggregated by geographic market areas that are consistent with industry market areas or boundaries, including the number of requests for such care and services under the laws administered by the Secretary.

“(B) An inventory of the health care capacity of the Department across the facilities of the Department.

“(C) An assessment of the health care capacity to be provided through contracted community care providers and providers who entered into a provider agreement with the Department under section 1703A of this title, including the number of providers, the geographic location of the providers, and categories or types of health care services provided by the providers.

“(D) An assessment obtained from other Federal direct delivery systems of their capacity to provide health care to veterans.

“(E) An assessment of the health care capacity of non-contracted providers where there is insufficient network supply.

“(F) An assessment of the health care capacity of academic affiliates and other collaborations of the Department as it relates to providing health care to veterans.

“(G) An assessment of the effects on health care capacity by the access and quality standards established under sections 1703B and 1703C of this title, respectively.

“(H) The number of appointments for health care services under the laws administered by the Secretary, disaggregated by—

“(i) appointments at facilities of the Department; and

“(ii) appointments with non-Department health care providers.

“(I) Analysis of information submitted from care coordination teams under section 1703(e)(2)(D) of this title from each Department medical facility that includes the following:

“(i) An analysis of coordination and management best practices.

“(ii) Satisfaction survey data from the covered veterans from each care coordination team under section 1703(e) of this title.

“(iii) Findings and determinations related to the coordination of care under section 1703(e) of this title to assist the Director in the design, implementation, and assessment of the high-performing integrated healthcare network of the Department.

“(iv) A standardized climate survey developed jointly with the Centers for Medicare & Medicaid Services Alliance to Modernize Healthcare (CAMH) for the employees of each medical facility of the Department that compiles data on culture, communication, teamwork, quality of worklife, rewards or recognition, leadership, and productivity.

“(3) The Secretary shall submit to the appropriate committees of Congress each market area assessment performed under paragraph (1) and the complete market area assessment being performed on the day before the date of the enactment of the Veterans Community Care and Access Act of 2017 in the same form as such assessments are delivered to the Secretary.

“(4) The Secretary shall use the market area assessments performed under paragraph (1) to inform the quadrennial Veterans Health Administration review and strategic plan under subsection (a) and to determine the capacity of the Department and the capacity of the health care provider networks established under section 1703(d) of this title.

“(5) The Secretary shall publish the capacity findings and results from the market area assessments performed under paragraph (1) with respect to the Department and health care provider networks established under section 1703(d) of this title on a publicly accessible Internet website of the Department.

“(d) Department budget.—The Secretary shall ensure that the budget request of the Department for any fiscal year (as submitted with the budget of the President under section 1105(a) of title 31) reflects the findings of the Secretary with respect to the most recent information described in subsection (b)(5) and is consistent with the quadrennial Veterans Health Administration review and strategic plan under subsection (a).

“(e) Appropriate committees of Congress defined.—In this section, the term ‘appropriate committees of Congress’ means—

“(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.”.

Ҥ 1703B. Access standards

“(a) In general.— (1) The Secretary shall establish access standards for hospital care, medical services, and extended care services furnished by the Department, including through health care providers under section 1703 of this title.

“(2) The Secretary shall ensure that the hospital care, medical services, and extended care services furnished to a veteran by the Department, including through health care providers under section 1703 of this title, is furnished within the access standards established under paragraph (1).

“(3) The access standards established under paragraph (1) shall align with the categories of hospital care, medical services, and extended care services set forth under subsection (b) and shall be informed by the market area assessments performed under section 1730B(c) of this title.

“(b) Categories of hospital care, medical services, and extended care services furnished.—The categories of hospital care, medical services, and extended care services subject to access standards established under subsection (a) are as follows:

“(1) Primary care services.

“(2) Specialty care services, including services that may require a referral and services that may be considered wellness or preventative care.

“(3) Behavioral health services, including mental health and substance abuse disorder treatment.

“(4) Urgent care.

“(5) Home health services, including services that may be virtual.

“(6) Dental services.

“(7) As determined by the Secretary, any additional types of services for which the Department or the networks established under section 1703(d) of this title have experienced increased demand according to the market area assessments performed under section 1730B(c) of this title or an increase in access complaints to network health care providers or the Department.

“(c) Application.— (1) The Secretary may establish and apply access standards under subsection (a) according to the market area assessments under section 1730B(c) of this title.

“(2) In carrying out section 1703 of this title, the Secretary shall apply access standards established under subsection (a) to a covered veteran under such section with respect to the residence, as defined in section 17.1505 of title 38, Code of Federal Regulations (or any successor regulation), of the covered veteran.

“(d) Comparative information.—The Secretary shall ensure that the access standards required by subsection (a) provide veterans, employees of the Department, and health providers in the Veterans Community Care Program established under section 1703 of this title with relevant comparative information that is clear, useful, and timely, so that veterans can make informed and responsible decisions regarding their hospital care, medical services, and extended care services.

“(e) Coordination.—The Secretary shall coordinate with the Secretary of Defense, and may consult with the Secretary of Health and Human Services, the Administrator of the Centers for Medicare & Medicaid Services, entities in the private sector, and other nongovernmental entities in establishing access standards under subsection (a).

“(f) Periodic review.—Not later than two years after the date on which the Secretary establishes access standards under this section and not less frequently than once every three years thereafter, the Secretary shall—

“(1) conduct a review of such standards; and

“(2) submit to the appropriate committees of Congress a report that includes the following:

“(A) A report on the findings of the Secretary with respect to the review conducted under paragraph (1) and any modification to such standards as the Secretary considers appropriate.

“(B) For each medical service line that the Secretary determined, during the period covered by the report, did not meet a standard established under this section, identification of the leadership team in the facility and the Veterans Integrated Service Network that are responsible for overseeing the progress of the medical service line in meeting such standard.

“(g) Publication.—The Secretary shall publish the health care access standards established under subsection (a) and any modifications to such standards in the Federal Register and on a publicly accessible Internet website of the Department.

“(h) Appropriate committees of congress defined.—In this section, the term ‘appropriate committees of Congress’ means—

“(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

Ҥ 1703C. Standards for quality

“(a) In general.— (1) The Secretary shall establish standards for quality regarding hospital care, medical services, and extended care services furnished by the Department, including through health care providers under section 1703 of this title.

“(2) The Secretary shall ensure that the hospital care, medical services, and extended care services furnished to a veteran by the Department, including through health care providers under section 1703 of this title, is furnished within the standards for quality established under paragraph (1).

“(3) The standards for quality established under paragraph (1) shall align with the Department of Defense according to categories of hospital care, medical services, and extended care services set forth under section 1703B(b) of this title and shall be informed by the market area assessments performed under section 1730B(c) of this title.

“(4) In establishing standards for quality under paragraph (1), the Secretary shall—

“(A) conduct a survey of covered veterans described in section 1703(b) of this title through a third party entity to assess the satisfaction of such veterans with service and quality of care; and

“(B) collect data sets that include, at a minimum—

“(i) general information;

“(ii) surveys of patients' experiences;

“(iii) timely and effective care;

“(iv) complications;

“(v) readmissions and deaths;

“(vi) use of medical imaging;

“(vii) payment and value of care; and

“(viii) use of telemedicine.

“(5) The Secretary shall develop such standards for quality and collect data according to health care settings consistent with the Department of Defense and the Centers for Medicare & Medicaid Services, including, at a minimum, the following:

“(A) Inpatient hospitals.

“(B) Nursing homes.

“(C) Individual health care providers.

“(D) Dialysis facilities.

“(E) Hospice.

“(F) Inpatient rehabilitation facilities.

“(G) Long-term care hospitals.

“(H) Outpatient facilities.

“(6) The standards for quality established under paragraph (1) shall be informed by existing health quality measures, such as those defined by the HealthCare Effectiveness Data and Information Set, that are applied to public and privately sponsored health care systems with the purpose of providing veterans relevant comparative information to make informed decisions regarding their health care.

“(b) Improving and strengthening quality standards.—Not later than one year after the date on which the Secretary establishes standards under subsection (a), the Secretary shall—

“(1) publish the quality rating of medical facilities of the Department on a publicly available Internet website, such as a website of the Centers for Medicare & Medicaid Services, for the purpose of providing veterans with information that allows them to compare performance measure information among Department and community health care providers who provide hospital care, medical services, or extended care services under section 1703 of this title; and

“(2) consider and solicit public comment on potential changes to the established quality measures to ensure that they include the most up-to-date and applicable industry measures for veterans.

“(c) Coordination.—The Secretary shall coordinate with the Secretary of Defense, and may consult with the Secretary of Health and Human Services, the Administrator of the Centers for Medicare & Medicaid Services, entities in the private sector, and other nongovernmental entities in establishing standards for quality under this section.

“(d) Periodic review.—Not later than two years after the date on which the Secretary establishes standards for quality under this section and not less frequently than once every three years thereafter, the Secretary shall—

“(1) conduct a review of such standards across the Department; and

“(2) submit to the appropriate committees of Congress a report that includes the following:

“(A) A report on the findings of the Secretary with respect to the review conducted under paragraph (1) and any modification to such standards as the Secretary considers appropriate.

“(B) For each medical service line that the Secretary determined, during the period covered by the report, did not meet a standard established under this section, identification of the leadership team in the facility and the Veterans Integrated Service Network that are responsible for overseeing the progress of the medical service line in meeting such standard.

“(e) Publication.—The Secretary shall publish the health care quality standards established under subsection (a) and any modifications to such standards in the Federal Register and on a publicly accessible Internet website of the Department.

“(f) Appropriate committees of congress defined.—In this section, the term ‘appropriate committees of Congress’ means—

“(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.”.

Ҥ 1703A. Agreements with eligible entities or providers; certification processes

“(a) Agreements authorized.— (1) (A) When hospital care, a medical service, or an extended care service is not available to a veteran described in section 1703(b) of this title from a medical facility of the Department or through a contract or sharing agreement entered into under this title under an authority other than this section, the Secretary may furnish such care or service to such veteran to avoid a delay or lapse in such care or service by entering into an agreement under this section with a health care provider specified in section 1703(c) of this title to provide such care or service.

“(B) An agreement entered into under this section to provide hospital care, a medical service, or an extended care service shall be known as a ‘Veterans Care Agreement’.

“(C) For purposes of subparagraph (A), hospital care, a medical service, or an extended care service may be considered not available to a veteran from a medical facility of the Department or through a contract or sharing agreement described in such subparagraph when the Secretary determines the veteran's medical condition, the travel involved, the nature of the care or services required, or a combination of these factors make the use of a facility of the Department or a contract or sharing agreement described in such subparagraph impracticable or inadvisable.

“(D) A Veterans Care Agreement may be entered into by the Secretary or any Department official authorized by the Secretary.

“(2) (A) Subject to subparagraph (B), the Secretary shall review each Veterans Care Agreement of material size, as determined by the Secretary or set forth in paragraph (3), for hospital care, a medical service, or an extended care service to determine whether it is feasible and advisable to provide such care or service within a facility of the Department or by contract or sharing agreement entered into pursuant to another provision of law and, if so, take action to do so.

“(B) (i) The Secretary shall review each Veterans Care Agreement of material size that has been in effect for at least six months within the first two years of its taking effect, and no less frequently than once every four years thereafter.

“(ii) If a Veterans Care Agreement has not been in effect for at least six months by the date of the review required by subparagraph (A), the agreement will be reviewed during the next cycle required by subparagraph (A), and such review will serve as its review within the first two years of its taking effect for purposes of clause (i).

“(3) In addition to such other Veterans Care Agreements as the Secretary may determine are of material size, each Veterans Care Agreement that takes effect after the date of the enactment of the Veterans Community Care and Access Act of 2017 shall be considered of material size.

“(4) (A) The Secretary, and any other Department official authorized by the Secretary, may enter into an agreement under this section for extended care services only if the Secretary does not expect such agreement would result in an obligation of the Department that exceeds a rate of $5,000,000 annually.

“(B) If the Secretary enters into an agreement with a provider under this section and pursuant to the agreement the Department incurs an obligation that exceeds an annual rate of, with respect to extended care services, the rate set forth in subparagraph (A), and with respect to services that are not extended care services, $2,000,000, the Secretary shall submit to the appropriate committees of Congress notice that such obligation has exceeded such rate and an accounting of the cost and need for such agreement if such provider is unable or unwilling to enter into a contract or other agreement under section 1703 of this title.

“(C) In this paragraph, the term ‘appropriate committees of Congress’ means—

“(i) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(ii) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

“(b) Eligible entities and providers.—For purposes of this section, an eligible entity or provider is—

“(1) any 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)) and any physician or other supplier who has enrolled and entered into a participation agreement under section 1842(h) of such Act (42 U.S.C. 1395u(h));

“(2) any provider participating under a State plan under title XIX of such Act (42 U.S.C. 1396 et seq.); or

“(3) any entity or provider not described in paragraph (1) or (2) of this subsection that the Secretary determines to be eligible pursuant to the certification process described in subsection (c).

“(c) Eligible entity or provider certification process.—The Secretary shall establish by regulation a process for the certification of eligible entities or providers or recertification of eligible entities or providers under this section. Such a process shall, at a minimum—

“(1) establish deadlines for actions on applications for certification;

“(2) set forth standards for an approval or denial of certification, duration of certification, revocation of an eligible entity or provider’s certification, and recertification of eligible entities or providers;

“(3) require the denial of certification if the Secretary determines the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a–7 or 1320a–7a) or is currently identified as an excluded source on 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;

“(4) establish procedures for screening eligible entities or providers according to the risk of fraud, waste, and abuse that are similar to the standards under section 1866(j)(2)(B) of the Social Security Act (42 U.S.C. 1395cc(j)(2)(B)) and section 9.104 and subpart 9.4 of title 48, Code of Federal Regulations, or successor regulations; and

“(5) incorporate and apply the restrictions and penalties set forth in chapter 21 of title 41 and treat this section as a procurement program only for purposes of applying such provisions.

“(d) Rates.—To the extent practicable, the rates paid by the Secretary for hospital care, medical services, and extended care services provided under a Veterans Care Agreement shall be in accordance with the rates paid by the United States under the Medicare program.

“(e) Terms of Veterans Care Agreements.— (1) Pursuant to regulations promulgated under subsection (k), the Secretary may define the requirements for providers and entities entering into agreements under this section based upon such factors as the number of patients receiving care or services, the number of employees employed by the entity or provider furnishing such care or services, the amount paid by the Secretary to the provider or entity, or other factors as determined by the Secretary.

“(2) To furnish hospital care, medical services, or extended care services under this section, an eligible entity or provider shall agree—

“(A) to accept payment at the rates established in regulations prescribed under this section;

“(B) that payment by the Secretary under this section on behalf of a veteran to a provider of services or care shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguish any liability on the part of the veteran for the treatment or care provided, and no provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate this requirement;

“(C) to provide only the care and services authorized by the Department under this section and to obtain the prior written consent of the Department to furnish care or services outside the scope of such authorization;

“(D) to bill the Department in accordance with the methodology outlined in regulations prescribed under this section;

“(E) to not 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 service for which payment is made by the Department;

“(F) to provide medical records to the Department in the time frame and format specified by the Department; and

“(G) to meet such other terms and conditions, including quality of care assurance standards, as the Secretary may specify in regulation.

“(f) Discontinuation or nonrenewal of a Veterans Care Agreements.— (1) An eligible entity or provider may discontinue a Veterans Care Agreement at such time and upon such notice to the Secretary as may be provided in regulations prescribed under this section.

“(2) The Secretary may discontinue a Veterans Care Agreement with an eligible entity or provider at such time and upon such reasonable notice to the eligible entity or provider as may be specified in regulations prescribed under this section, if an official designated by the Secretary—

“(A) has determined that the eligible entity or provider failed to comply substantially with the provisions of the Veterans Care Agreement, or with the provisions of this section or regulations prescribed under this section;

“(B) has determined the eligible entity or provider is excluded from participation in a Federal health care program under section 1128 or section 1128A of the Social Security Act (42 U.S.C. 1320a–7 or 1320a–7a) or is identified on the System for Award Management Exclusions list as provided in part 9 of title 48, Code of Federal Regulations, and part 180 of title 2 of such Code, or successor regulations;

“(C) has ascertained that the eligible entity or provider has been convicted of a felony or other serious offense under Federal or State law and determines the eligible entity or provider’s continued participation would be detrimental to the best interests of veterans or the Department; or

“(D) has determined that it is reasonable to terminate the agreement based on the health care needs of a veteran.

“(g) Quality of care.—The standards for quality established under section 1703C of this title shall be applied in monitoring the quality of care provided to veterans through Veterans Care Agreements and for assessing the quality of hospital care, medical services, and extended care services furnished by eligible entities and providers before the renewal of Veterans Care Agreements.

“(h) Disputes.— (1) The Secretary shall promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements.

“(2) Such procedures constitute the eligible entities’ and providers’ exhaustive and exclusive administrative remedies.

“(3) Eligible entities or providers must first exhaust such administrative procedures before seeking any judicial review under section 1346 of title 28 (known as the ‘Tucker Act’).

“(4) Disputes under this section must pertain to either the scope of authorization under the Veterans Care Agreement or claims for payment subject to the Veterans Care Agreement and are not claims for the purposes of such laws that would otherwise require application of sections 7101 through 7109 of title 41, United States Code.

“(i) Applicability of other provisions of law.— (1) A Veterans Care Agreement may be authorized by the Secretary or any Department official authorized by the Secretary, and such action is not an award for the purposes of such laws that would otherwise require the use of competitive procedures for furnishing of care and services.

“(2) (A) Except as provided in subparagraph (B), and unless otherwise provided in this section or regulations prescribed pursuant to this section, an eligible entity or provider that enters into an agreement under this section is not subject to, in the carrying out of the agreement, any law to which providers of services and suppliers under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) are not subject.

“(B) An eligible entity or provider that enters into an agreement under this section is subject to—

“(i) all laws regarding integrity, ethics, or fraud, or that subject a person to civil or criminal penalties; and

“(ii) all laws that protect against employment discrimination or that otherwise ensure equal employment opportunities.

“(j) Parity of treatment.—Eligibility for hospital care, medical services, and extended care services furnished to any veteran pursuant to a Veterans Care Agreement shall be subject to the same terms as though provided in a facility of the Department, and provisions of this chapter applicable to veterans receiving such care and services in a facility of the Department shall apply to veterans treated under this section.

“(k) Rulemaking.—The Secretary shall promulgate regulations to carry out this section.”.

Ҥ 1703D. Prompt payment standard

“(a) In general.— (1) Notwithstanding any other provision of this title or of any other provision of law, the Secretary shall pay for hospital care, medical services, or extended care services furnished by health care entities or providers under this chapter within 45 calendar days upon receipt of a clean paper claim or 30 calendar days upon receipt of a clean electronic claim.

“(2) If a claim is denied, the Secretary shall, within 45 calendar days of denial for a paper claim and 30 calendar days of denial for an electronic claim, notify the health care entity or provider of the reason for denying the claim and what, if any, additional information is required to process the claim.

“(3) Upon the receipt of the additional information, the Secretary shall ensure that the claim is paid, denied, or otherwise adjudicated within 30 calendar days from the receipt of the requested information.

“(4) This section shall only apply to payments made on an invoice basis and shall not apply to capitation or other forms of periodic payment to entities or providers.

“(b) Submittal of claims by health care entities and providers.—A health care entity or provider that furnishes hospital care, medical services, or extended care services under this chapter shall submit to the Secretary a claim for payment for furnishing the care or services not later than 180 days after the date on which the entity or provider furnished the care or services.

“(c) Fraudulent claims.— (1) Sections 3729 through 3733 of title 31 shall apply to fraudulent claims for payment submitted to the Secretary by a health care entity or provider under this chapter.

“(2) Pursuant to regulations prescribed by the Secretary, the Secretary shall bar a health care entity or provider from furnishing hospital care, medical services, and extended care services under this chapter when the Secretary determines the entity or provider has submitted to the Secretary fraudulent health care claims for payment by the Secretary.

“(d) Overdue claims.— (1) Any claim that has not been denied with notice, made pending with notice, or paid to the health care entity or provider by the Secretary shall be overdue if the notice or payment is not received by the entity or provider within the time periods specified in subsection (a).

“(2) (A) If a claim is overdue under this subsection, the Secretary may, under the requirements established by subsection (a) and consistent with the provisions of chapter 39 of title 31 (commonly referred to as the ‘Prompt Payment Act’), require that interest be paid on clean claims.

“(B) Interest paid under subparagraph (A) shall be computed at the rate of interest established by the Secretary of the Treasury under section 3902 of title 31 and published in the Federal Register.

“(e) Overpayment.— (1) The Secretary shall deduct the amount of any overpayment from payments due a health care entity or provider under this chapter.

“(2) Deductions may not be made under this subsection unless the Secretary has made reasonable efforts to notify a health care entity or provider of the right to dispute the existence or amount of such indebtedness and the right to request a compromise of such indebtedness.

“(3) The Secretary shall make a determination with respect to any such dispute or request prior to deducting any overpayment unless the time required to make such a determination before making any deductions would jeopardize the Secretary’s ability to recover the full amount of such indebtedness.

“(f) Information and documentation required.— (1) The Secretary shall provide to all health care entities and providers participating in a program to furnish hospital care, medical services, or extended care services under this chapter a list of information and documentation that is required to establish a clean claim under this section.

“(2) The Secretary shall consult with entities in the health care industry, in the public and private sector, to determine the information and documentation to include in the list under paragraph (1).

“(3) If the Secretary modifies the information and documentation included in the list under paragraph (1), the Secretary shall notify all health care entities and providers described in paragraph (1) not later than 30 days before such modifications take effect.

“(g) Processing of claims.—In processing a claim for compensation for hospital care, medical services, or extended care services furnished by a health care entity or provider under this chapter, the Secretary shall act through—

“(1) a non-Department entity that is under contract or agreement for the program established under section 1703(a) of this title; or

“(2) a non-Department entity that specializes in such processing for other Federal agency health care systems.

“(h) Report on encounter data system.— (1) Not later than 90 days after the date of the enactment of the Veterans Community Care and Access Act of 2017, the Secretary shall submit to the appropriate committees of Congress a report on the feasibility and advisability of adopting a funding mechanism similar to what is utilized by other Federal agencies to allow a contracted entity to act as a fiscal intermediary for the Federal Government to distribute, or pass through, Federal Government funds for certain non-underwritten hospital care, medical services, or extended care services.

“(2) The Secretary may coordinate with the Department of Defense, the Department of Health and Human Services, and the Department of the Treasury in developing the report required by paragraph (1).

“(i) Definitions.—In this section:

“(1) The term ‘appropriate committees of Congress’ means—

“(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

“(2) The term ‘clean electronic claim’ means the transmission of data for purposes of payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.

“(3) The term ‘clean paper claim’ means a paper claim for payment of covered health care expenses that is submitted to the Secretary which contains substantially all of the required data elements necessary for accurate adjudication, without obtaining additional information from the entity or provider that furnished the care or service, submitted in such format as prescribed by the Secretary in regulations for the purpose of paying claims for care or services.

“(4) The term ‘fraudulent claims’ means the intentional and deliberate misrepresentation of a material fact or facts by a health care entity or provider made to induce the Secretary to pay a claim that was not legally payable to that provider. This term, as used in this section, shall not include a good faith interpretation by a health care entity or provider of utilization, medical necessity, coding, and billing requirements of the Secretary.

“(5) The term ‘health care entity or provider’ includes any non-Department health care entity or provider, but does not include any Federal health care entity or provider.”.

Ҥ 1703E. Payment rates for community care

“(a) In general.—Except as provided in subsection (b), and to the extent practicable, the rate paid for hospital care or medical services under any provision in this title may not exceed the rate paid by the United States to a provider of services (as defined in section 1861(u) of the Social Security Act (1395x(u))) or a supplier (as defined in section 1861 (d) of such Act (42 U.S.C. 1395x(d))) under the Medicare program under title XI or title XVIII of the Social Security Act (42 U.S.C. 1301 et seq. and 1395 et seq.) for the same care or services, including rates adjusted for critical access hospitals under section 1834(g) of such Act (42 U.S.C. 1395m(g)).

“(b) Exception.— (1) (A) A higher rate than the rate paid by the United States as described in subsection (a) may be negotiated with respect to the furnishing of care or services to a veteran described in section 1703(b) of this title who resides in a highly rural area or in a market area where the availability of care or services is limited and a higher rate of pay may be required.

“(B) In this paragraph, the term ‘highly rural area’ means an area located in a county that has fewer than seven individuals residing in that county per square mile.

“(2) With respect to furnishing care or services under this section in Alaska, the Alaska Fee Schedule of the Department of Veterans Affairs shall be followed, except for when another payment agreement, including a contract, provider agreement or Veterans Care Agreement, is in place.

“(3) With respect to furnishing care or services under this section in a State with an All-Payer Model Agreement under section 1814(b)(3) of the Social Security Act (42 U.S.C. 1395f(b)(3)) that became effective on or after January 1, 2014, the Medicare payment rates under subparagraph (A) shall be calculated based on the payment rates under such agreement.

“(c) Value-Based reimbursement.—Notwithstanding subsection (a), the Secretary shall incorporate, to the greatest extent practicable, the use of value-based reimbursement models to promote the provision of high quality care.”.

Ҥ 8159. Authority to pay for services authorized but not subject to an agreement

“(a) In general.—If, in the course of furnishing hospital care, a medical service, or an extended care service authorized by the Secretary and pursuant to a contract, agreement, or other arrangement with the Secretary, a provider that is not a party to the contract, agreement, or other arrangement furnishes hospital care, a medical service, or an extended care service that the Secretary considers necessary, the Secretary may compensate the provider for the cost of such care or service.

“(b) Reports on use of authority.—Whenever the Secretary compensates a provider under subsection (a) for the furnishing of hospital care, a medical service, or an extended care service, the care coordination team that coordinated the furnishing of such care or service under section 1703(e)(1) of this title shall—

“(1) submit to the appropriate committees of Congress a report on the furnishing of such care; and

“(2) analyze the future demand for such care or service from such provider.

“(c) New contracts and agreements.—The Secretary shall take reasonable efforts to enter into a contract, agreement, or other arrangement with a provider described in subsection (a) to ensure that future care and services authorized by the Secretary and furnished by the provider are subject to such a contract, agreement, or other arrangement.

“(d) Definitions.—In this section:

“(1) The term ‘appropriate committees of Congress’ means—

“(A) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(B) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.

“(2) The terms ‘hospital care’ and ‘medical service’ have the meanings given such terms in section 1701 of this title.”.

Ҥ 1725A. Access to walk-in care

“(a) Procedures To ensure access to walk-In care.—The Secretary shall develop procedures to ensure that covered veterans are able to access walk-in care from qualifying non-Department entities or providers.

“(b) Covered veterans.—For purposes of this section, a covered veteran is any veteran described in section 1703(b) of this title.

“(c) Qualifying non-Department entities or providers.—For purposes of this section, a qualifying non-Department entity or provider is a non-Department entity or provider that—

“(1) has entered into a contract or other agreement with the Secretary to furnish services under this section; or

“(2) entered into an agreement with the Secretary that was in effect on the day before the date of the enactment of the Veterans Community Care and Access Act of 2017 to furnish walk-in care.

“(d) Federally-Qualified health centers.—Whenever practicable, the Secretary may use a 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))) to carry out this section.

“(e) Continuity of care.— (1) The Secretary shall ensure continuity of care for each covered veteran who receives a walk-in care service under this section through the care coordination team provided such covered veteran under section 1703(e)(1) of this title.

“(2) The Secretary shall inform and educate covered veterans on procedures to utilize and access walk-in care under this section.

“(3) The Secretary shall develop a mechanism to coordinate with qualifying non-Department entities or providers through the care coordination teams provided under section 1703(e)(1) of this title that includes the use of medical records from walk-in care providers to accurately represent access to care, health needs of the covered veterans, and to monitor conditions of covered veterans.

“(f) Copayments.— (1) The Secretary shall require each covered veteran to pay the United States a copayment for each episode of walk-in care provided under this section, except if the episode of walk-in care for the covered veteran is related to a service-connected disability of the covered veteran.

“(2) The Secretary may adjust the copayment required of a covered veteran under this subsection based upon the priority group of enrollment of the veteran, the number of episodes of care furnished to a covered veteran during a year, and other factors the Secretary considers appropriate under this section.

“(3) The amount or amounts of the copayments required under this subsection shall be prescribed by the Secretary by rule.

“(4) Copayments required by this subsection shall apply notwithstanding any other provision of law that would allow the Secretary to offset a covered veteran’s copayment obligation with amounts recovered from a third party under section 1729 of this title.

“(g) Regulations.—Not later than one year after the date of the enactment of the Veterans Community Care and Access Act of 2017, the Secretary shall promulgate regulations to carry out this section.

“(h) Walk-In care defined.—In this section, the term ‘walk-in care’ means non-urgent, non-emergent, convenience care provided by a qualifying non-Department entity or provider that furnishes episodic care and not longitudinal management of conditions and certain services as defined through contracts or agreements described in subsection (c) or regulations the Secretary shall prescribe for purposes of this section.”.

Ҥ 1730C. Licensure of health care professionals providing treatment via telemedicine

“(a) In general.—Notwithstanding any provision of law regarding the licensure of health care professionals, a covered health care professional may practice the health care profession of the health care professional at any location in any State, regardless of where in a State the covered health care professional or the patient is located, if the covered health care professional is using telemedicine to provide treatment to an individual under this chapter.

“(b) Covered health care professionals.—For purposes of this section, a covered health care professional is any health care professional who—

“(1) is an employee of the Department appointed under this title or title 5;

“(2) is authorized by the Secretary to provide health care under this chapter;

“(3) is required to adhere to all standards for quality relating to the provision of medicine in accordance with applicable policies of the Department; and

“(4) has an active, current, full, and unrestricted license, registration, or certification in a State to practice the health care profession of the health care professional.

“(c) Property of Federal government.—Subsection (a) shall apply to a covered health care professional providing treatment to a patient regardless of whether the covered health care professional or patient is located in a facility owned by the Federal Government during such treatment.

“(d) Relation to State law.— (1) The provisions of this section shall supersede any provisions of the law of any State to the extent that such provision of State law are inconsistent with this section.

“(2) No State shall deny or revoke the license, registration, or certification of a covered health care professional who otherwise meets the qualifications of the State for holding the license, registration, or certification on the basis that the covered health care professional has engaged or intends to engage in activity covered by subsection (a).

“(e) Rule of construction.—Nothing in this section may be construed to remove, limit, or otherwise affect any obligation of a covered health care professional under the Controlled Substances Act (21 U.S.C. 801 et seq.).”.

Ҥ 726. Annual report on awards to certain high-level employees

“(a) In general.—Not later than 30 days after the end of each fiscal year, the Secretary shall submit to the appropriate committees of Congress a report that contains, for the most recent fiscal year ending before the submittal of the report, a description of the performance awards and bonuses awarded to Regional Office Directors of the Department, Directors of Medical Centers of the Department, and Directors of Veterans Integrated Service Networks.

“(b) Elements.—Each report submitted under subsection (a) shall include the following with respect to each award or bonus awarded to an individual described in such subsection:

“(1) The type of award or bonus, specifically those awarded for performance or on the basis of recruitment, relocation and retention as the case may be.

“(2) The amount of each award or bonus.

“(3) The job title of the individual awarded the award or bonus.

“(4) The location where the individual awarded the award or bonus works.

“(c) Appropriate committees of congress.—In this section, the term ‘appropriate committees of Congress’ means—

“(1) the Committee on Veterans’ Affairs and the Committee on Appropriations of the Senate; and

“(2) the Committee on Veterans’ Affairs and the Committee on Appropriations of the House of Representatives.”.

Ҥ 8111B. Authority to plan, design, construct, or lease a shared medical facility

“(a) In general.— (1) The Secretary may enter into agreements with other Federal agencies for the planning, designing, constructing, or leasing shared medical facilities with the goal of improving access to, and quality and cost effectiveness of, health care provided by the Department and other Federal agencies.

“(2) Facilities planned, designed, constructed, or leased under paragraph (1) shall be managed by the Director of the High-Performing Integrated Healthcare Network of the Department designated under section 1730B(a) of this title.

“(b) Transfer of amounts to other Federal agencies.— (1) The Secretary may transfer to another Federal agency amounts appropriated to the Department for ‘Construction, Minor Projects’ for use for the planning, design, or construction of a shared medical facility if the estimated share of the project costs to be borne by the Department does not exceed the threshold for a major medical facility construction project under section 8104(a)(3)(A) of this title.

“(2) The Secretary may transfer to another Federal agency amounts appropriated to the Department for ‘Construction, Major Projects’ for use for the planning, design, or construction of a shared medical facility if—

“(A) the estimated share of the project costs to be borne by the Department is more than the threshold for a major medical facility construction project under subsection (a)(3)(A) of section 8104 of this title; and

“(B) the requirements for such a project under such section have been met.

“(3) The Secretary may transfer to another Federal agency amounts appropriated to the applicable appropriations account of the Department for the purpose of leasing space for a shared medical facility if the estimated share of the lease costs to be borne by the Department does not exceed the threshold for a major medical facility lease under section 8104(a)(3)(B) of this title.

“(c) Transfer of amounts to Department.— (1) Amounts transferred to the Department by another Federal agency for the necessary expenses of planning, designing, or constructing a shared medical facility for which the estimated share of the project costs to be borne by the Department does not exceed the threshold for a major medical facility project under section 8104(a)(3)(A) of this title may be deposited in the ‘Construction, Minor Projects’ account of the Department and used for such necessary expenses.

“(2) Amounts transferred to the Department by another Federal agency for the necessary expenses of planning, designing, or constructing a shared medical facility for which the estimated share of the project costs to be borne by the Department is more than the threshold for a major medical facility project under section 8104(a)(3)(A) of this title may be deposited in the ‘Construction, Major Projects’ account of the Department and used for such necessary expenses if the requirements for such project under section 8104 of this title have been met.

“(3) Amounts transferred to the Department by another Federal agency for the purpose of leasing space for a shared medical facility may be credited to the applicable appropriations account of the Department and shall be available without fiscal year limitation.

“(4) Amounts transferred under paragraphs (1) and (2) shall be available for the same time period as amounts in the account to which those amounts are transferred.”.

Ҥ 1703F. Center for Innovation for Care and Payment

“(a) In general.— (1) There is established within the Department a Center for Innovation for Care and Payment (in this section referred to as the ‘Center’).

“(2) The Secretary, acting through the Center, may carry out such pilot programs as appropriate to develop new, innovative approaches to testing payment and service delivery models to reduce expenditures while preserving or enhancing the quality of care furnished by the Department.

“(3) The Secretary, acting through the Center, shall test payment and service delivery models to determine whether such models improve the access to and quality, timeliness, and patient satisfaction of such care and services, as well as the cost savings associated with such models.

“(4) (A) The Secretary shall test models where the Secretary determines that there is evidence that the model addresses a defined population for which there are deficits care leading to poor clinical outcomes or potentially avoidable expenditures.

“(B) The Secretary shall focus on models expected to reduce program costs while preserving or enhancing the quality of care received by individuals receiving benefits under this chapter.

“(C) The models selected may include those described in section 1115A(b)(2)(B) of the Social Security Act (42 U.S.C. 1315a(b)(2)(B)).

“(5) In selecting models for testing, the Secretary may consider the following additional factors:

“(A) Whether the model includes a regular process for monitoring and updating patient care plans in a manner that is consistent with the needs and preferences of applicable individuals.

“(B) Whether the model places the applicable individual, including family members and other caregivers of the applicable individual, at the center of the care team of the applicable individual.

“(C) Whether the model uses technology or new systems to coordinate care over time and across settings.

“(D) Whether the model demonstrates effective linkage with other public sector payers, private sector payers, or statewide payment models.

“(6) (A) Models tested under this section may not be designed in such a way that would allow the United States to recover or collect reasonable charges from a Federal health care program for care or services furnished by the Secretary to veterans under pilot programs carried out under this section.

“(B) In this paragraph, the term ‘Federal health care program’ means—

“(i) an insurance program described in section 1811 of the Social Security Act (42 U.S.C. 1395c) or established by section 1831 of such Act (42 U.S.C. 1395j); or

“(ii) a State plan for medical assistance approved under title XIX of such Act (42 U.S.C. 1396 et seq.); or

“(iii) a TRICARE program operated under sections 1075, 1075a, 1076, 1076a, 1076c, 1076d, 1076e, or 1076f of title 10.

“(b) Duration.—Pilot programs carried out by the Secretary under this section shall terminate no later than five years after their commencement.

“(c) Location.—The Secretary shall ensure that pilot programs carried out under this section occur in different areas that are appropriate for the intended purposes of the pilot program.

“(d) Budget.—Funding for pilot programs carried out by the Secretary under this section will be derived from appropriations provided in advance in appropriations Acts for the Veterans Health Administration and from appropriations provided for information technology systems.

“(e) Notice.—The Secretary shall publish information about such pilot programs in the Federal Register, and shall take reasonable actions to provide direct notice to veterans eligible to participate in a pilot program operated under this section.

“(f) Waiver of authorities.— (1) Subject to reporting under paragraph (2) and approval under paragraph (3), in implementing the pilot programs under this section, the Secretary may waive such requirements in subchapters I, II, and III of this chapter as may be necessary solely for the purposes of carrying out this section with respect to testing models described in subsection (a).

“(2) Before waiving any authority under paragraph (1), the Secretary shall submit a report to the Speaker of the House of Representatives, the minority leader of the House of Representatives, the majority leader of the Senate, the minority leader of the Senate, and each standing committee with jurisdiction under the rules of the Senate of the House of Representatives to report a bill to amend the provision or provisions of law that would be waived by the Department describing in detail the following:

“(A) The specific authorities to be waived under the pilot program.

“(B) The standard or standards to be used in the pilot program in lieu of the waived authorities.

“(C) The reasons for such waiver or waivers.

“(D) A description of the metric or metrics the Secretary will use to determine the effect of the waiver or waivers upon the access to and quality, timeliness, or patient satisfaction of care and services furnished through the pilot program.

“(E) The anticipated cost savings, if any, of the pilot program.

“(F) The schedule for interim reports on the pilot program describing the results of the pilot program so far and the feasibility and advisability of continuing the pilot program.

“(G) The schedule for the termination of the pilot program and the submission of a final report on the pilot program describing the result of the pilot program and the feasibility and advisability of making the pilot program permanent.

“(H) The estimated budget of the pilot program.

“(3) (A) Upon receipt of a report submitted under paragraph (2), each House shall provide copies of the report to the chairman and ranking member of each standing committee with jurisdiction under the rules of the House of Representatives or the Senate to report a bill to amend the provision or provisions of law that would be waived by the Department under this subsection.

“(B) (i) The waiver requested by the Secretary under paragraph (2) shall be considered approved under this paragraph if there is enacted into law a bill or joint resolution approving such request in its entirety. Such bill or joint resolution shall be passed by recorded vote to reflect the vote of each member of Congress thereon.

“(ii) The provisions of this paragraph are enacted by the Congress—

“(I) as an exercise of the rulemaking power of the Senate and the House of Representatives and as such shall be considered as part of the rules of each House, and shall supersede other rules only to the extent that they are inconsistent therewith; and

“(II) with full recognition of the constitutional right of either House to change the rules (so far as they relate to the procedures of that House) at any time, in the same manner, and to the same extent as in the case of any other rule of that House.

“(C) During the 60-calendar-day period beginning on the date on which the Secretary submits the report described in paragraph (2) to Congress, it shall be in order as a matter of highest privilege in each House of Congress to consider a bill or joint resolution, if offered by the majority leader of such House (or a designee), approving such request in its entirety.

“(g) Limitations.— (1) The waiver provisions in subsection (f) shall not be available unless the Secretary submits the first proposal, in accordance with the requirements in subsection (f), for a pilot program within 18 months of the date of the enactment of the Veterans Community Care and Access Act of 2017.

“(2) Notwithstanding section 502 of this title, decisions by the Secretary under this section shall, consistent with section 511 of this title, be final and conclusive and may not be reviewed by any other official or by any court, whether by an action in the nature of mandamus or otherwise.

“(3) (A) If the Secretary determines that the pilot program is not improving the quality of care or producing cost savings, the Secretary shall—

“(i) propose a modification to the pilot program in the interim report that shall also be considered a report under subsection (f)(2)(A) and shall be subject to the terms and conditions of subsection (f)(2); or

“(ii) terminate such pilot program within 30 days of submitting the interim report to Congress.

“(B) If the Secretary terminates the pilot program under subparagraph (A)(ii), for purposes of clauses (vi) and (vii) of subsection (f)(2)(A), such interim report will also serve as the final report for that pilot program.

“(h) Evaluation and reporting requirements.— (1) The Secretary shall conduct an evaluation of each model tested, which shall include, at a minimum, an analysis of—

“(A) the quality of care furnished under the model, including the measurement of patient-level outcomes and patient-centeredness criteria determined appropriate by the Secretary; and

“(B) the changes in spending by reason of that model.

“(2) The Secretary shall make the results of each evaluation under this subsection available to the public in a timely fashion and may establish requirements for other entities participating in the testing of models under this section to collect and report information that the Secretary determines is necessary to monitor and evaluate such models.

“(i) Coordination and consultation.— (1) The Secretary shall obtain advice from the Under Secretary for Health and the Special Medical Advisory Group established pursuant to section 7312 of this title in the development and implementation of any pilot program operated under this section.

“(2) In carrying out the duties under this section, the Secretary shall consult representatives of relevant Federal agencies, and clinical and analytical experts with expertise in medicine and health care management. The Secretary shall use appropriate mechanisms to seek input from interested parties.

“(j) Expansion of successful pilot programs.—Taking into account the evaluation under subsection (f), the Secretary may, through rulemaking, expand (including implementation on a nationwide basis) the duration and the scope of a model that is being tested under subsection (a) to the extent determined appropriate by the Secretary, if—

“(1) the Secretary determines that such expansion is expected to—

“(A) reduce spending without reducing the quality of care; or

“(B) improve the quality of patient care without increasing spending; and

“(2) the Secretary determines that such expansion would not deny or limit the coverage or provision of benefits for applicable individuals.”.